The conclusion of the advisory board demonstrates the necessity of introducing a new risk category for cardiovascular complications: the extreme risk category. The article presents the analysis of the studies that were the basis for the introduction of this risk category. The following patients groups may be classified as an extreme risk category: combination of clinically significant atherosclerotic cardiovascular disease with diabetes mellitus type 2; atherosclerotic cardiovascular disease with cardiovascular complications occurred despite adequate lipid lowering therapy and/or achieved LDL cholesterol level <1.5 mmol/l. Management of extreme risk patients is discussed, that includes not only requirements of achievement of LDL cholesterol, blood pressure and HbA1c target levels, but also using of drugs with proved effectiveness in reducing cardiovascular risk.