OBJECTIVE: To investigate the association between anthropometric indicators and cardiovascular and cerebrovascular disease (CCVD) mortality risk in elderly patients with type 2 diabetes mellitus (T2DM). METHODS: This retrospective cohort study included 897 elderly T2DM patients who received long-term follow-up from January 2017 to January 2020. Baseline data included demographics, medical history, and anthropometric indicators such as body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). The primary outcome was CCVD-related mortality. A Cox proportional hazards model was used to analyze associations between physical measurements and CCVD mortality risk. RESULTS: During a mean follow-up of 7.13 ± 2.45 years, 45 CCVD-related deaths occurred, with a mortality rate of 70.37 per 10,000 person-years. Cox regression analysis showed that higher WHtR was significantly associated with increased CCVD mortality risk in the overall population. Subgroup analyses revealed that elevated WHR predicted higher mortality risk in males, while increased BMI and WHtR were associated with greater CCVD mortality risk in females. Among patients without dyslipidemia or hyperuricemia, elevated WHtR also indicated increased mortality risk. CONCLUSION: Elevated WHtR is an independent predictor of CCVD mortality in elderly T2DM patients. WHR in males and BMI in females are also important risk factors. Monitoring and managing abdominal obesity may help reduce CCVD-related deaths in this population.