OBJECTIVES: Diabetic patients are at CHD greater risk than the general population. Therefore these patients will benefit from optimal care based on CHD risk evaluation. We assessed the potential impact of risk factors (RF) management on the cardiovascular (CV) risk among T2DM population. METHODS: A retrospective cohort study was conducted in Spain (2006-2007). Patients were aged ≥30 years at time of T2DM diagnosis and had added sulphonylurea or PPARg agonist to previous metformin. Patient RFs were assessed for attainment of guideline-defined optimal values. The data for these patients correspond to their last available measurements before add-on therapy. Five-year CV risk was estimated with a diabetic-specific model. An array of scenarios were created simulating patient adequately controlled LDL-C, both LDL-C and HDL-C, all three lipid parameters and all modifiable RFs (the previous plus smoking, SBP and HbA1c). RESULTS: A total of 318 patients were included in this analysis. Average age 63.1 (SD 10.6) years and 47% were female. Less than 20% of the patients presented LDL-C at target levels and ~60% of patients show HDL-C and/or triglycerides at the recommended levels. Among these patients SBP and HbA1c were ~20% at target levels. Actual 5-years risk estimate was 51.6% (SD 0.3). The proportion of maximum potential CV Risk Reduction (calculated as Absolute Risk Reduction [ARR] divided by maximum ARR [ARR/MaxARR]), by simulated scenarios were: 42.4% (if LDL-C at target), 58% (if LDL-C and HDL-C at target); 67.5% (if all three lipid-parameters at target); and if all modifiable RF were at target for all patients the estimated risk was 31.1% and the maximum risk reduction 100%. CONCLUSIONS: T2DM patients starting OCT frequently have their lipids not at target increasing their CV risk. Hence to reduce this risk it is required to comprehensively manage them in order to achieve the maximum benefit.