The adipocytokine, visfatin, exerts a diverse variety of effects that include the ability to mimic the glucose-lowering effects of insulin. In addition to its anti-hyperglycaemic action, recent evidence suggests that visfatin may be responsible for a number of different cardiovascular effects, depending on the cell type and the duration of therapy, one of which includes the ability to protect the myocardium from the detrimental effects of acute ischaemia-reperfusion injury. As such visfatin may not only provide a potential new target for acute cardioprotection but it may also act as an anti-diabetic agent with a unique mechanism of action, thereby offering a potentially novel drug target for the diabetic patient that experiences an episode of acute myocardial ischaemia-reperfusion injury.