Framingham risk score (FRS) is a widely used tool to identify asymptomatic individuals who are at risk to cardiovascular disease. We aimed to investigate the association between subclinical atherosclerosis and FRS among elderly with both type 2 diabetes mellitus and healthy participants. As case-control study was done on 58 men and women, who had type 2 diabetes mellitus, and in 59 age and gender matched control participants. They were selected from a geriatric outpatient clinic at Ain Shams University Hospital, Cairo, Egypt. The carotid intima-media thickness (cIMT), clinical variables, plasma lipid profile, high-sensitivity C-reactive protein (hs-CRP) were measured for each participants. Diabetic patients had higher FRS, body mass index (BMI), fasting glucose, total cholesterol level, and LDL levels than control subjects. Mean cIMT values were higher in diabetic than healthy subjects. After multivariate regression analysis, FRS was independently associated with carotid IMT in type 2 diabetes patients after adjustment for other risk factors. However triglycerides and BMI were independently associated with cIMT among the control group. FRS is likely to be more informative about the atherosclerotic state in diabetics but not in the healthy elderly.