ObjectiveThelimited information available concerning the role of periostin associated with cardiovascular risk in patients with type 2 diabetes mellitus (T2DM). Therefore, this study aimed to find out the association between periostin level and inflammatory markers in patients with T2DM as well as in the acute coronary syndrome (ACS) patients. MethodsThis cross-sectional study randomly included a total of 210 participants, comprising T2DM (n = 130), ACS (n = 40), and healthy group (n = 40). All anthropometric measures and biochemical parameters, periostin level, high sensitivity C-reactive protein (hs-CRP), and white blood cell (WBC) count were estimated. Pearson's correlation and linear multiple regression analysis was performed to assess the correlation and association between periostin level and other variables. ResultsSerum periostin levels were significantly higher among obese T2DM and ACS patients as compared to control. Positive correlation was found between serum periostin levels and waist circumference (WC), body mass index (BMI), fasting plasma glucose (FPG), postprandial glucose (PPG), glycated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), hs-CRP, WBC count, while negative correlation was observed with high-density lipoprotein (HDL) (p < 0.05). After adjustment, regression analysis showed that BMI, HbA1c, TC, HDL, WBC and hs-CRP were independently related to serum periostin levels (p < 0.001). ConclusionThe evidence of current study suggested that periostin levels were significantly higher among patients with ACS and obese T2DM, and it is significantly associated with lipid profile, anthropometric measures and inflammatory biomarkers. Our results revealed that periodic estimation of the circulating serum periostin could be a biomarker to predict the risk of developing cardiovascular complications in patients with T2DM.However, lacking of follow-up it further creates room for the future investigation.