Hyperglycemia elicits activation of protein kinase C, and elevation of advanced glycation endproducts and oxidative stress. These changes activate proliferation and migration of vascular smooth muscle cell inducing atherogenesis. Recently, the attention has been paid to the relation between diabetic atherosclerosis and extracellular matrix protein, osteopontin or epigenetic moduration in vascular smooth muscle cells. Hyperglycemia also accelerates platelet aggregation through the alteration of multiple signal transduction pathways. Thus, the anticoagulation drugs seems to be effective for the prevention of cardiovascular disease in type 2 diabetes. However, in JPAD trial, the use of aspirin failed to show the primary preventive effect for cardiovascular events. Further prospective studies to elucidate the effect of anticoagulant for the prevention of atherosclerosis are needed.