Patients with Diabetes Mellitus (DM) have increased risk of atherosclerosis and up to half die during the first myocardial infarction. Primary prevention of cardiovascular disease (CVD) should be a major goal in the management of DM patients. DM patients with the highest risk (established CVD or chronic kidney disease) should have aggressive lipid-lowering therapy. Statin therapy should be the first line of therapy for all DM patients with elevated LDL-C. Ezetimibe can be added if LDL-C target is not reached at maximally tolerated statin dose. Fibrates can be used in DM patients with TG of >4.5 mmol/l (400 mg/dl). The adverse effects from lipid-lowering therapy are low while the benefits of intervention are well proven and significant.