Macrovascular complications associated with chronic hyperglycemia in type 2 diabetes mellitus is a major global health problem that is currently on the rise. Accelerated cardiovascular and cerebrovascular atherosclerosis is the major cause of mortality in patients with type 2 diabetes. Many of the risk factors for cardiovascular disease are operative or even exacerbated in diabetic patients, including hypercholesterolemia, hypertriglyceridemia, hypertension, central obesity, and smoking. Other diabetes-specific factors, such as increased levels of plasminogen activator 1 and fibrinogen, chronic inflammation, genetic susceptibility, and accelerated glycosylation end-products-mediated vascular damage, are thought to play a role in the development of CVD among patients with type 2 diabetes. Further studies will hopefully elucidate the clinical relevance of such factors. In addition, recent studies indicate that hyperglycemia is an important and independent risk factor for CVD. Increased risk of CVD is directly related to elevated 1 and 2 hour post-prandial blood glucose averages, as well as to fasting hyperglycemia. Thus, specific treatment regimens designed to reduce the development rate of cardiovascular complications in patients with type 2 diabetes must consider the impact of risk factors and their control, as well as the need for optimal metabolic and glycemic control.