To assess whether metabolic syndrome may be a useful tool for stratifying cardiovascular risk, data from 5928 subjects with type 2 diabetes were analyzed as to the presence of metabolic syndrome (WHO criteria) and macrovascular diseases. Metabolic syndrome was associated with an increased prevalence of ischemic heart disease (IHD) (P<0.0001), coronary artery bypass graft (CABG) (P<0.0003), peripheral vascular disease (PVD) (P=0.08) and stroke (P=0.002) for all ages. Metabolic syndrome patients had an IHD prevalence equivalent to that of 10-year older subjects without metabolic syndrome. Furthermore, there was a strong correlation between the number of metabolic syndrome risk factors and IHD prevalence (p = 0.0001). Metabolic syndrome had the biggest impact on the 40-49 years age group (P<0.05), this impact decreasing with progressively increasing ages. Consequently, metabolic syndrome may be particularly useful in further stratifying vascular risk in younger patients with type 2 diabetes and in those with a high number of metabolic syndrome risk factors. Such sub-stratification may help to better define younger subjects with type 2 diabetes in order to target interventions aimed at decreasing CV disease development and progression.