Gender-based differences in the prevalence, presentation, and treatment of coronary heart disease (CHD) defines an important area of controversy and research. Gender-based differences include age at onset of CHD, typical presentation of CHD symptoms, relative importance of coronary risk factors, and the potential relationship of ovarian function and estrogen status to the development of CHD. The American Heart Association reported in 1998 that the leading cause of death for American women is cardiovascular disease, with CHD responsible for the majority of total deaths. This article discusses the implication of elevated blood lipids in women. Special emphasis is placed on the role of hormone replacement therapy, an issue unique to women.