Previous analysis of data from the Framingham Heart Study and the Framingham Eye Study showed that the "all-cause" death rate for diabetic persons with lens opacities was more than twice that of diabetic persons without lens opacities. Additional follow-up information was used to investigate whether these lens changes were associated with cardiovascular morbidity and mortality in particular. At the eye examination (1973 to 1975) there were 133 diabetic persons with no cardiovascular disease, of whom 41% had lens changes. Of these 133 persons, 57 had at least one cardiovascular event by the time of the most recent follow-up examination (1981 to 1983). Regression analyses suggested an increased risk of cardiovascular events among diabetic persons with lens changes (incidence rate ratio = 1.8; p = 0.07). Specifically there were associations of lens changes with the development of congestive heart failure (incidence rate ratio = 3.6; p = 0.01) and coronary heart disease (incidence rate ratio = 2.4; p = 0.08). Thus lens changes, in addition to being early prognostic signs of mortality, appear to be predictors of cardiovascular disease in adult-onset diabetes.