OBJECTIVE: To study the predictive value of medial artery calcification (Mönckeberg's sclerosis) in relation to 10-year cardiovascular mortality in patients with non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: We studied the predictive value of thigh medial and intimal artery calcifications to 10-year cardiovascular mortality in a well-characterized group of 133 middle-aged, newly diagnosed patients with NIDDM (70 men and 63 women). RESULTS: At baseline, medial artery calcifications were found in 17% of the patients and intimal-type calcifications were found in 23%. During the follow-up, 21% of the diabetic patients died from cardiovascular causes. The age-adjusted odds ratio for cardiovascular mortality was 4.2 (95% confidence intervals: 1.5−11.3) for medial-type and 1.6 (0.6−4.3) for intimal-type calcifications. In multiple logistic regression analysis, including age, sex, systolic blood pressure, low-density- and high-density-lipoprotein cholesterol, very-low-density lipoprotein triglycerides, smoking, body mass index, fasting serum insulin, blood glucose, urinary albumin, and ischemic ECG changes, as well as the intimal artery calcification, the medial artery calcification was the dominant factor predicting cardiovascular mortality. CONCLUSIONS: In this study medial artery calcification was a strong independent predictor of cardiovascular mortality in patients with newly diagnosed NIDDM. Whether these subjects had a longer duration of hyperglycemia before the diagnosis than those without medial artery calcifications remains unknown.