In a large longitudinal study, we examined the relationships between cardiovascular risk factors (blood lipids, blood pressure, smoking, and physical activity), and change in these risk factors over a 7-year period, and the risk of clinical diabetes mellitus type 2. There were 73 verified new cases of clinical diabetes mellitus type 2 (diagnosed between 1987 and 1995) and 9,982 controls who consistently denied diabetes in three health surveys in 1979/1980, 1986/1987, and 1994/1995. Baseline body mass index, serum triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and physical activity in leisure, as well as change in these risk factors, were significant predictors for clinical diabetes mellitus type 2. Thus, both the level of risk factors at baseline and change in risk factor level are of importance for the risk of clinical diabetes mellitus type 2.