Evidence accumulated from several large-scale epidemiological and intervention studies strongly indicates that hyperglycaemia and specifically post-challenge hyperglycaemia is an independent factor related to the increased risks of cardiovascular disease. The DECODE (Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe) study has de-emphasized the importance of fasting glucose, in contrast to post-challenge hyperglycaemia, as the principal measurable determinant of glycaemic exposure contributing to the risk of cardiovascular disease in Type 2 diabetes and even in non-diabetic subjects. The study, based on five Finnish DECODE study cohorts, demonstrated that in subjects without previous myocardial infarction, 2-h post-challenge glucose after an oral glucose tolerance test was a stronger predictor of the risk of serious coronary heart disease events than fasting glucose. Post-challenge hyperglycaemia was identified as an independent risk factor for cardiovascular disease also in Cardiovascular Health Study and the Framingham Offspring Study. It seems fair to conclude that post-challenge glucose is likely to be an independent cardiovascular risk factor. The mechanism for the increased risk in the incidence and mortality related to post-challenge hyperglycaemia has been speculated. To recognize that post-challenge hyperglycaemia is an important risk factor for cardiovascular disease may be of a significant preventive importance.