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Background: T-C/HDL-C has limited value to predict macrovascular complicatians in diabetes because the changes of cholesterol are not signifieant. Hypertriglyceridemia with low HDL-C has been supposed as a risk factor. We found previously that the plasma Lp(a) level was increased in NIDDM patients with the macrovascular disease. Therefore we hypothesized that the diabetic dyslipidemia index {DDI=(LDL-C+triglyceride)/ HDL-C+Lp(a)} may be related to the development of macrovascular complication in NIDDM more than other atherosclerosis indices. The aim of this study is to confirm this hypothesis. Methods: The subjects are 62 NIDDM patients which are classified as two groups. Group DM (n=31) is the NIDDM patients with macrovascular complications. The plasma level of TC,TG,HDL-C, LDL-C,Lp(a) is measured LDL-C/HDL-C, (LDL-C+TG)/HDL-C, Apoprotein B/A poprotein AI(Apo B/AI) and DDI [DDI=(LDL-C+TG)/HDLC+Lp(a)] as atherosclerosis indices are calculated. Results: 1) LDL-C/HDL-C is increased significantly in group DMMCX compared with group DM. 2) (LDL-C+TG)/HDL-C is increased significantly in group DMMCX compared to group DM. 3) Apo B/Al is increased significantly in group DMMCX compared to group DM. 4) DDI is increased significantly in group DMMCX compared to group DM. 5) Through multiple logistic regression analysis, regression coefficients and relative risks are 0.386, 11.9 in DDI (p<0.001), 0.013, 5.22 in LDL-C/HDL-C (p<0.001), 0.071, 5.97 in (LDL-C+TG)/HDL-C (p=0.032), and 0.07, 7.2 in Apo B/Al (p=0.036). 6) Sensitivity and specificity of DDI for macrovascular complications in NIDDM are 80%, 74% respectively. Positive predictive value and negative predictive value are 75%, 80% respectively. Conclusion: Among atherosclerosis indices, diabetic dyslipidemia index is best to discriminate the complication of macrovascular diseases in the NIDDM patients.