Cardiovascular disease is a major killer in women yet is frequently considered a male-dominated disease. The risk of cardiovascular disease in women is frequently underestimated and there is also considerable evidence of a treatment bias against women. Women are generally underrepresented in cardiovascular clinical trials yet there is evidence of gender-specific differences in the responses to pharmacotherapy. The Sibutramine Cardiovascular Outcomes (SCOUT) trial has been designed to determine whether weight management with sibutramine together with a diet- and exercise-based lifestyle intervention can prevent cardiovascular morbidity and mortality in high-risk overweight and obese patients. The SCOUT population includes a large number of older women, at high risk for cardiovascular disease. Data from the trial's lead-in phase indicate that treatment with sibutramine and lifestyle management for 6 weeks result in clinically important weight loss and reduction in waist circumference. Despite an initial lower body weight, older women with cardiovascular disease and diabetes mellitus appear to lose as much weight as men. In the overall SCOUT population, treatment with sibutramine is associated with small median decreases in systolic and diastolic blood pressure and small median increases in pulse rate. The side-effect profile of sibutramine in this older, 'at-risk' population was similar to that previously observed in younger patients.