Abstract: Objective: To investigate the association of pancreatic steatosis with Framingham risk score(FRS) in patients with type 2 diabetes mellitus(DM).Methods: Patients with type 2 DM undergoing abdominal CT in our hospital were enrolled in the study from January 2018 to February 2019.CT attenuation of pancreas and the spleen was measured on nonenhanced CT images, and CT attenuation indexes was calculated(The difference between pancreatic and splenic attenuation and the ratio of pancreas-to-spleen attenuation).Pancreatic steatosis was defined as pancreatic attenuations below median levels.The demographic data and biochemical indexes were collected from all the participants.According to FRS, all patients were divided into low-risk, mid-risk and high-risk group.Kruskal-Wallis rank test or Chi-square test was used to assess differences of clinical and imaging data in each group.Spearman correlation was used to assess the correlation between CT attenuation of pancreas, CT attenuation indexes and Framingham risk score.Multiple Logistic regression analysis was used to analyze the related factors of Framingham risk score.Results: Totally 161 consecutive patients with type 2 DM were included in this study.There were significant differences in CT attenuation of pancreas(Z=11.320, P=0.001), P-S(Z=0.324, P=0.002) and P/S(Z=9.908, P=0.002) between low risk group and higher risk group.There were significant differences in CT attenuation of pancreatic head, body and tail in high-risk group(Z=10.239, P=0.006).Spearman correlation showed that CT attenuation of pancreas(r=-0.312, P<0.0001), P-S(r=-0.280, P=0.0003) and P/S(r=-0.287, P=0.0002) were negatively correlated with Framingham risk score.After adjusting for confounding factors, CT attenuation of pancreas(OR=0.950, 95%CI: 0.910-0.991;P=0.018), P-S(OR=0.943, 95%CI: 0.895-0.992;P=0 024), P/S(OR=0.040, 95%CI: 0.003-0.571;P=0.018) and pancreatic steatosis(OR=2.825, 95%CI: 1.150-6.940;P=0.024) were still associated with the risk of cardiovascular events.Conclusion: CT attenuation of pancreas and CT attenuation indexes were independently associated with risk score of cardiovascular events in patients with type 2 DM, suggesting that pancreatic steatosis may indicate the risk of cardiovascular events in these patients.