OBJECTIVES: To determine the population attributable risk (PAR) of macrovascular events associated with HbA1c, systolic blood pressure (SBP), or weight (BMI) in patients with type 2 diabetes mellitus (T2DM). METHODS: The population-based PHARMO database contains T2DM patients regularly monitored in primary care for cardiovascular risk factors HbA1c, SBP and BMI. In the period 2000-2008 patients without baseline macrovascular events and on antidiabetic treatment for ≥6 months were followed from start of monitoring until monitoring ended. Multivariate survival modeling of the composite outcome of macrovascular events was used to estimate the expected number of events after 5 years, either with unchanged risk factors (base-case) or with reductions in risk factors. The PAR was calculated as the number of averted events divided by the number of expected events in the base-case analysis. RESULTS: Mean age of 5841 included patients was 66 years (55% male), 45% had HbA1c levels ≥7%, 66% had a SBP ≥140 mmHg and 85% had a BMI >25 kg/m2. The base case expected number of macrovascular events at 5 years was 796, and 687 after reduction to target of all 3 risk factors. The combined PAR of elevated HbA1c, SBP and BMI was 14%, ranging from 5% among those with one elevated risk factor to 21% among those with three risk factors elevated. Incremental reductions of 0.5% HbA1c, 10mmHg SBP and 10% BMI led to 4% fewer events, ranging from 2-10%. The PAR of reducing HbA1c to target (7%) was 5%, ranging from 2-10%. The PAR of reducing SBP to target (135 mmHg) was 9%, ranging from 3-12%. There was no effect of reduction in BMI alone. CONCLUSIONS: Reducing elevated HbA1c and blood pressure levels was associated with improvements in cardiovascular risk. Even modest reductions in risk factors lead to significant reductions in macrovascular events in T2DM patients.