Although epidemiologic analyses suggest a correlation between higher rates of cardiovascular disease and chronic hyperglycemia, to date, no randomized clinical trial has convincingly demonstrated a beneficial effect of intensive therapy on macrovascular outcomes in individuals with long-standing type 2 diabetes. In contrast, intensive initial control in individuals with newly diagnosed diabetes has long-term benefit in decreasing the risk of myocardial infarction, diabetes-related death, and overall death. There is strong, consistent evidence that the relationship between blood glucose levels and cardiovascular risk extends into the no diabetic range and obesity. Therefore, multifactorial risk reduction should be a top priority for prevention of macrovascular complications. We should keep in mind that obesity and diabetes also increase the risk of heart failure independent of coronary heart disease and hypertension and may cause a cardiomyopathy, a frequent, forgotten, and often fatal complication. This multifactorial disease should be treated by a multidisciplinary team.