A longitudinal prospective study was undertook to investigate the effect of multifactorial target control, recommended by the American Diabetes Association (ADA), on macrovascular disease in patients with short-duration type 2 diabetes. Patients who were newly diagnosed with type 2 diabetes or within 1 year and had no previous vascular diseases or atherosclerosis plaques were enrolled in the present study. All patients received multifactorial intervention, with pharmacologic therapy targeting hyperglycemia, hypertension, dyslipidemia, along with secondary prevention of vascular disease with aspirin when necessary according to the ADA recommendation. Patients were followed up for 8 years (2002-2010). The ultrasounds of arteries (carotid, iliac and femoral arteries) were measured every year. The primary endpoint was the time to the first occurrence of atherosclerosis plaques of the arteries. The second endpoint was clinical evidence of cardiovascular diseases. One hundred and forty-three patients were recruited, and the mean age was 50 (6.92) years. During the study, atherosclerosis plaques occurred in 49 patients. Systolic blood pressure less than 130 mmHg [hazard ratio (HR), 0.236; 95 % confidence interval (CI) 0.076-0.734; P = 0.013] and fasting plasma glucose less than 7 mmol/l (HR, 0.457; 95 % CI 0.210-0.994; P = 0.048) were significantly associated with decreased onset of atherosclerosis plaques. Simultaneous target control of systolic blood pressure and fasting plasma glucose reduced the risk of atherosclerosis plaques by 18 % (P = 0.097) and cardiovascular diseases by 16 % (P = 0.046). Multifactorial target treatment in patients with short-duration type 2 diabetes can effectively reduce the risk of macrovascular complications.