Background: Atherosclerotic cardiovascular disease (ASCVD) is the major cause of death and disability in patients with type 2 diabetes. Objective: The aim of the research was to study the differences between male and female diabetic patients as regard the prevalence of macrovascular complications in Sohag Governorate, Upper Egypt. Methods: This Study was a cross sectional study on diabetes mellitus in Upper Egypt. The study included 500 diabetic patients randomly selected from rural and urban areas of Sohag Governorate. all patients were subjected to: history taking, clinical examination, blood pressure and pulse evaluation, ECG, echocardiography and laboratory investigations including blood glucose and HbA1c estimation. Results: 500 diabetics patients included in this study, 44.2% of them were males while 55.8% were females. one third of males were smokers and body mass index was statistically higher in females than males. No difference between male and female diabetics as regard control of diabetes or lipogram. The prevalence of hypertension, heart failure with reduced ejection fraction (HFrEF), and diastolic dysfunction were higher in males with significant difference. Peripheral arterial disease was higher in females while stroke was higher in males but with no significant difference. Conclusion: Macrovascular complications are prevalent among male and female diabetic patients. Hypertension, HFrEF and diastolic dysfunction were higher in males than females with significant difference.