The greatest clinical challenge in type 2 diabetes mellitus is the prevention of its long-term complications, many of which are of a cardiovascular nature. Despite the progress in cardiovascular risk management of diabetes patients using lipid-lowering and antihypertensive drugs, a substantial residual risk persists. Indeed, treated diabetes patients have a similar risk as untreated nondiabetic individuals. Although glycemic control through the use of antihyperglycemic agents improves microvascular complications, macrovascular disease risk is not reduced. These observations point to the need for additional therapeutic approaches in order to better control global cardiovascular risk. The peroxisome proliferator-activated receptor (PPAR) family members play major roles in the regulation of lipid and glucose metabolism and immune-inflammatory processes, making these transcription factors ideal targets for such therapeutic strategies. This review discusses our current knowledge of the effectiveness of PPAR-based therapeutics, focusing exclusively on cardiovascular disease in type 2 diabetes mellitus and the future prospects for novel generation of PPAR agonists.