Although cardiovascular disease is the leading cause of death in women, they are often more concerned about developing breast cancer than about developing heart disease. Women’s heart disease risk tends to lag about 10 years behind that of men; thus at any given age, a woman’s baseline risk will be lower than that of a man. However, cardiovascular disease remains the leading cause of death in women. While some heart disease risk factors such as age and family history are not modifiable, as with men, other risk factors such as hypertension, hyperlipidemia, smoking, obesity, and diabetes are potentially modifiable. Decision making about treatment of some of these risk factors is affected by overall cardiovascular risk. The Framingham risk calculator (http://cvdrisk.nhlbi.nih.gov/) can be used to estimate a woman’s 10-year risk of coronary heart disease (CHD) based on her age, smoking status, blood pressure, and cholesterol levels. In addition to the risk factors in the Framingham risk calculator, the pooled cohort equations to predict 10-year risk of atherosclerotic cardiovascular disease (ASCVD) include race (white or other vs African American) and diabetes (http://clincalc.com/Cardiology/ASCVD/PooledCohort.aspx). Beyond treatment of risk factors such as hypertension, diabetes, and hyperlipidemia, decision making about whether to take aspirin for cardiovascular disease prevention is important. Some studies have suggested that aspirin may be helpful for primary prevention of stroke in women but not for primary CHD prevention, and recent studies suggest that aspirin may not reduce all-cause mortality when used for primary prevention. Current guidelines regarding aspirin for primary prevention of cardiovascular disease are not gender specific and focus on balancing the overall risk of cardiovascular disease against the risk of bleeding. Cardiovascular disease, risk factors, and therapeutic options for risk factor reduction and prevention are discussed in Chapter 1-04.