Diabetes is well established as a cardiovascular risk factor and is currently regarded as a coronary artery disease equivalent. However, some recent data have contradicted the concept. We review the currently available data and usefulness or otherwise of this concept. While the concept of coronary artery disease equivalence has served to highlight the importance of diabetes as a risk factor, it has a number of problems. We propose that it would be more useful to consider diabetes as a myocardial infarction risk equivalent. This is not only more precise and in line with the literature but also conveys better the message that patients with diabetes and one or more previous myocardial infarction(s) are at even higher risk.