There is considerable disparity between the major clinical guidelines on lipid targets in diabetes and metabolic syndrome. Over the past few years, several trials have reported results that contribute to the evidence base for such lipid targets. The Treat to New Targets study data provide support for the efficacy and safety of using high-dose statin therapy for reducing low-density lipoprotein cholesterol (LDL-C) to at least 2 mmol/L in patients with diabetes and established cardiovascular disease (CVD). The Collaborative Atorvastatin Diabetes Study and the Heart Protection Study provide support for the efficacy and safety of lowering LDL-C to at least 2 mmol/L with lower doses of statins. Once these LDL-C targets have been reached, it is unknown whether targeting high-density lipoprotein cholesterol (HDL-C) and triglycerides is more efficacious than further lowering of LDL-C. The optimal treatment strategy, therefore, is unclear. Trials are underway to resolve this question. Patients with metabolic syndrome derive similar relative reduction in CVD from statin therapy as those without, and the appropriate treatment and targets depend on the estimated CVD risk. Prediction of CVD risk with currently available risk scores is imperfect but there is little evidence that including metabolic syndrome improves risk prediction beyond Framingham Risk Score mainly because the latter already includes blood pressure and HDL-C.