An effective strategy for the prevention of cardiovascular disease in patients with diabetes is needed with the epidemic of diabetes mellitus around the world. The aims are to cut morbidity and mortality from coronary heart disease by risk factor reduction and to reduce the diabetic complications of retinopathy, renal disease and peripheral vascular disease. Findings of the United Kingdom Prospective Diabetes Study (UKPDS) imply that all diabetics should be subject to intensive glycaemia control and tight blood pressure control. GISSI-3 and the DIGAMI studies showed the benefits of lisinopril and an insulin/glucose infusion, respectively, post-MI. The HOPE study set out to examine whether ramipril reduced cardiovascular events in patients at high risk: the results were highly significant. The statin studies 4S, CARE and WOSCOPS showed the value of statins in primary and secondary prevention of cardiovascular events in patients with diabetes. Low-dose aspirin therapy should be used in patients with diabetes who are at high risk of cardiovascular events.