OBJECTIVE: To compare the incidence of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) with the incidence in patients with type 2 diabetes mellitus (DM2) and that in the general population. DESIGN: Prospective, descriptive cohort study. METHOD: In 2001-2002, 353 patients with RA were included in a cohort. All patients were seen after 3 years to determine the 3-year incidence of CVD. Cox proportional hazards models were used to compare this incidence with the 3-year incidence of CVD in a general population cohort consisting of 1852 people, of which 155 had DM2. Fatal and non-fatal CVD were classified according to the ICD-9 criteria. RESULTS: The 3-year incidence of CVD was 9.0% in patients with RA and 4.3% in the general population, corresponding to an incidence of 3.30 per 100 patient-years (95% CI: 2.08-4.25) and 1.51 per 100 person-years (95% CI: 1.18-1.84) respectively. Compared with the 1852 people in the general population cohort, the age and sex-adjusted hazard ratio for CVD in RA patients was 1.94 (95% CI: 1.24-3.05; p = 0.004). This risk did not change when patients with pre-existing CVD were excluded or when the analyses were adjusted for the presence of cardiovascular risk factors. Both RA patients without DM2 and patients with DM2 had a twofold increased risk of CVD risk compared with the general population without DM2, with hazard ratios of 2.16 (95% CI: 1.28-3.63) and 2.04 (95% CI: 1.12-3.67) respectively. CONCLUSION: RA is associated with an increased risk of CVD and this risk is similar to that associated with DM2.