Prediabetes is an intermediate condition between normal glycemia and clinical diabetes. Person with prediabetes condition have more chances of occurring diabetes and its associated cardiovascular disorder. Intervention of prediabetic person reduces its progression to diabetes and other cardiovascular diseases. Pioglitazone, a thiazolidinedione insulin sensitizer acts on peroxisome proliferator activated receptor and have a good response in diabetic condition. Apart from glycemic benefits it has anti-atherogenicity action that prevents the progression of cardiovascular disorder. These emerging effects of the drug pioglitazone on atherosclerosis warrant a better place in the management of diabetic patients with high risk of coronary artery disease.