OBJECTIVES: To investigate and compare the factors predictive of major adverse cardiovascular events (MACE) in atherosclerotic cardiovascular disease (ASCVD) patients with and without diabetes mellitus.  METHODS: Adults with established coronary heart disease, cerebrovascular disease, or peripheral artery disease were identified from the Taiwanese Secondary Prevention for Patients with AtheRosCLErotic Disease (T-SPARCLE) multi-center registry. Medical history and baseline characteristics were collected at enrollment, and clinical outcomes were followed on a regular basis. Cox proportional hazards models were used to determine risk factors associated with the occurrence of MACE, with analysis stratified based on presence or absence of diabetes. Potential risk or protective factors analyzed include age, gender, body mass index, smoking status, medical conditions (hypertension, heart failure, diabetes, chronic kidney disease, type of ASCVD and intervention performed), lipid profiles, and use of statin treatment.  RESULTS: A total of 2,295 patients were included, with mean age of 65.4, 75.4% male, and 79.5% having coronary heart disease. Among the included study subjects, approximately 38% (n=871) had diabetes. In this diabetic population, risk of MACE was significantly increased with chronic kidney disease (CKD) stage 4-5 (eGFR ≦30 ml/min) (vs. stage 1-2: hazard ratio [HR] 3.64 [95% CI 1.35-9.86]) and LDL-C ≧130 mg/dL (vs. LDL-C <70mg/dL: HR 4.30 [1.30-14.22]). Moreover, increased non-HDL-C levels were associated with a more prominent event risk, as compared to using LDL-C as a lipoprotein level indicator in the model. Among non-diabetic individuals, however, history of heart failure was the only significant independent predictor of MACE (HR 2.8 [1.28-6.14]).  CONCLUSIONS: Our study demonstrates that lipid profiles and advanced renal disease are predictive of adverse cardiovascular outcomes in atherosclerotic patients with diabetes, whereas history of heart failure confers a higher risk for MACE in non-diabetic atherosclerotic patients. It is therefore suggested that ASCVD patients with concomitant diabetes need stricter control of their lipid levels.