Metabolic syndrome and diabetes are associated with increased risk of cardiovascular diseases (CVD). It is associated with an increased risk for CVD, CVD mortality, stroke and myocardial infarction (MI). Therapy should be focused on weight reduction, especially visceral fat reduction. These include lifestyle modifications, pharmacological interventions including anti-obesity drugs, lipid management (e.g., statins), antihypertensive drugs (ACE inhibitors, angiotensin receptor blockers or ARBs) and antithrombotic therapy like aspirin. Metabolic syndrome is also associated with an increased risk for developing type 2 diabetes. Lifestyle or pharmacological interventions in individuals with impaired glucose tolerance (IGT) have a significant effect in reducing progression to diabetes. Management of individual risk factors, including hyperlipidemia, hypertension and hyperglycemia is required in established diabetes. Antithrombotic therapy like aspirin may be beneficial in reducing the risk of cardiovascular events in diabetes. In conclusion, reducing the risk of CVD in patients with metabolic syndrome and diabetes requires comprehensive management involving lifestyle changes accompanied by pharmacological therapy, wherever necessary.