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Diabetes mellitus is now recognized as a cardiovascular risk equivalent to that of coronary heart disease.It is associated with a two-to fourfold excess risk of coronary heart disease.Patients with metabolic syndrome or type 2 diabetes mellitus have a characteristic lipid profile known as diabetic dyslipidaemia.Although the degree of glycemia in diabetic patients is strongly correlated with the risk of microvascular complications (retinopathy and renal disease), the relation of glycemia to macrovascular disease in type 2 diabetes is more modest.It is the dyslipidaemia, characterized by only minimal changes from normal, plays a more important role in macrovascular risk.It includes normal or mildly elevated total cholesterol concentration, normal concentration of low density lipoprotein cholesterol (LDL-C), borderline low concentration of high density lipoprotein cholesterol (HDL-C) and mild hypertriglyceridaemia.Clinicians may underestimate the significance of the cardiovascular (CV) risk associated with this lipid profile as the lipid fractions are either normal or only slightly deviated from normal.However, it carries a substantial part of increased cardiovascular risk in these patients.This lipid profile is also present in women with polycystic ovarian syndrome and in individuals with familial combined hyperlipidaemia, which is the most common genetic form of dyslipidaemia.Together with the obesity epidemic and high prevalence of diabetes mellitus, diabetic dyslipidaemia is the most common dyslipidaemia nowadays.Despite its minimal changes from normal, diabetes dyslipidaemia associates with significant increased cardiovascular risk because it is also characterized by the concurrent detrimental qualitative changes.There are overproduction of apolipoprotein B and very low density lipoprotein (VLDL), reduction in apolipoprotein A1 and significant postprandial hypertriglyceridaemia.The metabolism of lipoproteins also leads to the formation of large quantity of small, dense LDL particles.These qualitative changes are often not reported in clinical laboratory reports as they tend to focus on quantitative assessment.It is important for clinicians to understand the mechanism of small,dense LDL particles formation and changes in HDL metabolism that lead to the subtle but yet harmful changes in order to recognise the risk associated with this lipid profile so that appropriate treatment can be provided.Subgroup analyses of a few recent major clinical trials have confirmed that even optimal LDL-C lowering and intensive blood pressure and glucose control cannot eliminate the CV risk of diabetic patients, especially if they have this diabetic dyslipidaemia profile.Obviously, a multifactorial approach to prevention of CHD in type 2 diabetes is needed.It must rely on lifestyle changes and combination pharmacotherapy.In addition, there is new evidence to support the needs for more aggressive triglyceride lowering and HDL-C raising approaches to minimise the impact of the residual risk in these patients.Lipid treatment guidelines, new treatment approaches will be discussed.In addition, new therapeutic agents that will be available soon or in the near future will also be introduced.