The role of diabetes in the pathogenesis of cardiovascular disease was unclear until 1979 when Kannel and McGee used data from the Framingham Heart Study to identify diabetes as a major cardiovascular risk factor. It was among the first studies to demonstrate the higher risk of cardiovascular disease in women with diabetes than in men with diabetes. Since then, multiple studies have been done to recognize and curtail cardiovascular risk factors such as smoking, obesity, hypertension, hyperlipidemia, and insulin resistance. This review will examine the contribution of the Kannel and McGee paper and subsequent studies in defining the contribution of several risk factors on cardiovascular disease.