Vascular disease is one of the common complications of diabetes mellitus including macrovascular disease and microvascular disease. Macrovascular disease （commonly refers to atherosclerosis） which leads to cardiac-cerebral vascular disease is a major cause of death in patients with type 2 diabetes mellitus. Although diabetic macrovascular disease has become one of hot research in the diabetic complications field, the underlying mechanism is still far from being completely elucidated. This review describes current situation and prospect concerning hyperinsulinemia and atherosclerosis and discusses the possible pathogenesis.