To an increasing degree, cardiology and endocrinology are finding a broadening interface. There is little doubt that atherosclerosis is in many ways a metabolic disorder, just as it is becoming increasingly clear that diabetes is a vascular disease. Framing such notions is evidence of diabetes as a risk equivalent for coronary disease, and clinical cardiovascular trials demonstrate the impact of altering lipid metabolism. Although the focus has been on statins and LDL, data continues to emerge for other therapies for triglycerides and HDL. These issues are discussed, as are future directions for metabolic therapeutic interventions for vascular disease.