Both type 2 diabetes mellitus and atherosclerosis grow from the common soil of the metabolic syndrome. Thus, the interventions preventing the development of type 2 diabetes, will delay with a high probability also the development of atherosclerosis. Clinical studies showed that lifestyle and therapeutic interventions leading to decrease in the degree of obesity, as well as drugs increasing insulin sensitivity, could prevent type 2 diabetes. Such interventions could be indicated as primary prevention with respect to the development of atherosclerosis in type 2 diabetes. Secondary prevention includes interventions in diabetic patients without cardiovascular disease and tertiary prevention includes interventions in diabetics with macrovascular disease. Treatment of dyslipidemia, hypertension and achieving the best possible glycemic control led to decreased incidence of cardiovascular complications in the frame of secondary and tertiary prevention studies. Antiplatelet treatment is indicated mainly in tertiary prevention. Multifactorial interventions aiming at all modifiable risk factors halved the incidence of macrovascular disease. Even higher effect of multifactorial interventions can be expected if these will target the high risk group of subjects with metabolic syndrome.