Type 2 diabetics with advanced atherosclerosis, for example those with retinopathy, have very high cardiovascular disease (CVD) risk, comparable to a prior CVD. According to the Japanese guideline (JAS2017), the LDL-C target for diabetics is <120 mg/dL for primary prevention with or without diabetic complications. For secondary prevention, the target is lowered to <100 mg/dL. In European (EAS/ESC2016) and Korean (2015 Treatment Guidelines for Diabetes) guidelines, the target LDL-C level for high-risk diabetics (including secondary prevention) is < 70 mg/dL. The target LDL-C level for high-risk Asian diabetics should be reevaluated. In the EMPATHY study, hypercholesterolemic type 2 diabetics with retinopathy, but without CVD, were randomly assigned to intensive therapy targeting LDL-C < 70 mg/dL or standard therapy targeting LDL-C 100~120 mg/dL (Itoh H et al. Diabetes Care 2018). Patients were treated to achieve specific LDL-C targets by titrating statin. LDL-C was lowered to 76.5 mg/dL in the intensive and 104.1 mg/dL in the standard group. The event rate for primary endpoint (PE), consisting of CVD and CVD death, did not differ between the groups (HR0.84,= 0.15). However, the intensive therapy reduced cerebral events in secondary endpoints. Post hoc analysis showed that significantly less PE occurred in the intensive group in which LDL-C targets were successfully achieved (p = 0.007). The REAL-CAD, including Japanese patients with stable CVD, showed that high-dose (4 mg) as compared with low-dose (1 mg) pitavastatin significantly reduced CVD events. The achieved LDL-C levels were 76.6 mg/dL in the high-dose group. Considering that patients of the REAL-CAD had high CVD risk as with those of the EMPATHY, LDL-C level is suggested to be lowered to around 70 mg/dL for high risk Asian population. In conclusion, achieving LDL-C < 70 mg/dL in high-risk Asian diabetics, such as those with retinopathy, may be beneficial.