Cardiovascular disease (CVD) is the leading cause of mortality for women and among women, the number of deaths secondary to CVD is nearly twice the number of all cancer-related deaths. Mortality trends from 1979 to 2001 have shown a consistent decrease in cardiovascular mortality among men; however, cardiovascular mortality trends have remained steady or increased among women. This disparity in outcomes, in part, is secondary to a lack of awareness among women and their health care providers regarding a woman's risk for CVD. A woman's risk for CVD should be assessed at routine evaluation. Primary prevention, including lifestyle and medical interventions, should be undertaken based on risk assessment. Initiation of menopausal hormone therapy is not recommended for the prevention of coronary heart disease or stroke in women.