Type 2 diabetes mellitus confers an increased risk for cardiovascular disease (CVD), in part owing to the effects of the metabolic syndrome, a clustering of risk factors that often accompanies the diabetic state. It is likely that the combination of hypertension, diabetic dyslipidemia, hyperglycemia, and insulin resistance produces an enhanced, atherogenic environment within the circulation. In keeping with a multifactorial approach to CVD risk reduction, intensive glycemic control could hypothetically have multiple beneficial effects on the metabolic and macrovascular systems of the patient with type 2 diabetes. When considering risk factor modification in this population, it is important to consider both the biological mechanisms of disease and the social determinants that contribute to disparities in health.