Coronary artery disease and type 2 diabetes are chronic diseases of substantial and growing prevalence. Although diabetes is a strong independent risk factor for cardiovascular events, this risk is not confined to glucose levels above the diagnostic threshold for diabetes. Rather, there is now a growing consensus that nondiabetic hyperglycemia measured by fasting glucose, postload glucose or glycated hemoglobin is a progressive, continuous risk factor for cardiovascular outcomes. Whether dysglycemia is a marker for a more complex metabolic condition or may directly contribute to excess cardiovascular risk is still a matter of debate. While strategies designed to normalize glucose levels in people with type 2 diabetes remain inconclusive, diabetes prevention trials suggest that along with reduction of the rate of conversion toward diabetes, a significant improvement in cardiovascular risk factors occurs. Moreover, a number of ongoing studies may provide answers to this question. Recognition that nondiabetic hyperglycemia is associated with an increased cardiovascular risk may suggest new ways for preventing cardiovascular disease.