Individuals with type 2 diabetes mellitus suffer from a higher incidence of coronary heart disease (CHD) compared with those without diabetes. The mechanisms for the increased CHD in diabetic patients are multifactorial, including endothelial dysfunction, vessel wall modification, hyperglycemic toxicity, oxidative stress and inflammation, and insulin resistance. Moreover, multifactorial intervention, other than glycemic control alone, is recognized as the promising strategy for diabetic patients with CHD. In this review, the roles of the major contributors to the development of CHD and the comprehensive management strategies dealing with diabetes mellitus are focused upon.