Older reports of greater diabetes-associated increment in cardiovascular disease in women compared with men are confirmed in the recent reports of the Strong Heart Study of Native Americans. In that study, a greater apoprotein B level was seen in diabetic women, in keeping with a greater triglyceride, very low density lipoprotein C (VLDL-C), and lower high density lipoprotein C (HDL-C) level compared to men in previous studies. Greater total and low density lipoprotein (LDL) cholesterol levels may be seen as well. Lipoprotein abnormalities in diabetic women also predict the development of significant albuminuria in diabetic women compared with men and the development of diabetes itself which is a problem. Therapeutic interventions involving walking, triple drug therapy, and postmenopausal estrogen all offer promise. Major cardiovascular prevention trials have shown benefits in diabetic subjects but also have not differentiated response by gender. Such studies are greatly needed because of the greater degree of dyslipidemia and cardiovascular risk in diabetic women.