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Non-alcoholic fatty liver disease (NAFLD) is associated with an increased prevalence of cardiovascular disease (CVD) in both non-diabetic and Type 2 diabetic individuals. We sought to examine whether NAFLD is associated with prevalent CVD in patients with Type 1 diabetes.We studied 343 (156 men; mean age ~45 yr) consecutive Type 1 diabetic patients with and without NAFLD, which was diagnosed by ultrasonography. The presence of CVD was diagnosed by patient history, chart review, electrocardiogram, and echo-Doppler scanning of carotid and lower limb arteries.Compared with those without steatosis, patients with ultrasound-diagnosed NAFLD (no.=182) had a remarkably greater age- and sex-adjusted prevalence of coronary (15.4 vs 1.2%, p0.0001), cerebrovascular (41.7 vs 9.3%, p0.0001) and peripheral (29.7 vs 6.2%, p0.0001) vascular disease. A multivariable logistic regression analysis revealed that NAFLD was associated with an ~8-fold higher odds of CVD (composite endpoint), independently of age, sex, body mass index, family history of CVD, smoking status, physical activity, alcohol consumption, diabetes duration, glycated hemoglobin, systolic blood pressure, plasma lipids, estimated glomerular filtration rate, albuminuria, and use of anti-hypertensive, lipid-lowering and anti-platelet medications (adjusted odds ratio 7.6, 95% confidence intervals 3.6-24.0, p0.001).Our results demonstrate that NAFLD is associated with an increased prevalence of asymptomatic/symptomatic CVD in patients with Type 1 diabetes, independently of several established risk factors, including the components of metabolic syndrome.