Atherosclerotic cardiovascular disease (ASCVD), including acute coronary syndrome (ACS), myocardial infarction (MI), angina, arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease, is the leading cause of mortality for individuals with type 2 diabetes (T2D) and is the largest contributor to the economic costs of diabetes. Cardiac troponin (cTn) concentration is the preferred marker of myocardial necrosis. Elevated concentrations of cTn have a strong association with an adverse prognosis in patients with ACS and are used to identify patients who are likely to benefit from an early invasive management strategy. High-sensitivity troponin (hsTn) assays that allow the measurement of very low cTn levels in patients with stable heart disease are now available for clinical and research use. This chapter covers the high-sensitivity troponin in screening ASCVD risk in type 2 diabetes, prognostic information in stable ischemic heart disease, high-sensitivity troponin in type 2 diabetes and therapeutic implication.