Methylglyoxal (MGO) is a reactive dicarbonyl compound and a potential key player in diabetic cardiovascular disease (CVD). Whether plasma MGO levels are associated with CVD in type 2 diabetes is unknown. We included 1,003 individuals (mean ± SD age 59.1 ± 10.5 years, 69.3% male, and 61.6% with prior CVD) with type 2 diabetes from the Second Manifestations of ARTerial disease cohort (SMART). We measured plasma MGO levels and two other dicarbonyls (glyoxal GO and 3-deoxyglucosone 3-DG) at baseline with mass spectrometry. Median follow-up of CVD events was 8.6 years. Data were analyzed with Cox regression with adjustment for sex, age, smoking, systolic blood pressure, total cholesterol, HbA , BMI, prior CVD, and medication use. Hazard ratios are expressed per SD Ln-transformed dicarbonyl. A total of 287 individuals suffered from at least one CVD event ( = 194 fatal events, = 146 myocardial infarctions, and = 72 strokes); 346 individuals died, and 60 individuals underwent an amputation. Higher MGO levels were associated with total (hazard ratio 1.26 95% CI 1.11-1.42) and fatal (1.49 1.30-1.71) CVD and with all-cause mortality (1.25 1.11-1.40), myocardial infarction (1.22 1.02-1.45), and amputations (1.36 1.05-1.76). MGO levels were not apparently associated with stroke (1.03 0.79-1.35). Higher GO levels were significantly associated with fatal CVD (1.17 1.00-1.37) but not with other outcomes. 3-DG was not significantly associated with any of the outcomes. Plasma MGO and GO levels are associated with cardiovascular mortality in individuals with type 2 diabetes. Influencing dicaronyl levels may therefore be a target to reduce CVD in type 2 diabetes.