Type 2 diabetes mellitus (T2DM) is one of the most common chronic metabolic disorders associated with severe cardiovascular complications. Among these complications, diabetic angiopathy and ischemic heart disease (IHD) occupy a leading position in morbidity and mortality worldwide. Chronic hyperglycemia contributes to vascular endothelial damage, oxidative stress, inflammation, and accelerated atherosclerosis, all of which play critical roles in the pathogenesis of coronary artery disease. Diabetic angiopathy affects both microvascular and macrovascular circulation, leading to impaired myocardial perfusion and increased risk of ischemic events. This article discusses the major pathogenic mechanisms linking diabetic angiopathy with the development of ischemic heart disease in patients with type 2 diabetes mellitus. Understanding these mechanisms is essential for early diagnosis, prevention, and effective therapeutic strategies aimed at reducing cardiovascular complications in diabetic patients.