Cardiovascular disease accounts for 38% of deaths in women, whereas breast cancer accounts for 4% of deaths. Coronary heart disease affects males and females equally. Whereas mortality from vascular and coronary heart disease appears to be decreasing in men, it is increasing in women, and this presents a major challenge to primary care clinicians. The prevalence, presentation and management of coronary heart disease and certain risk factors differ in women. Diabetes and low high-density-lipoprotein-cholesterol levels exert a relatively greater atherogenic effect, and the menopause is also a cardiovascular risk factor. Hypertension is unusual in young women, and usually coexists with other cardiovascular risk factors. Physical inactivity is associated with other cardiovascular risk factors. Regular physical activity reduces cardiovascular risk by at least 50%. Despite its reduced accuracy in women, exercise testing should be used as the preferred stress test for investigating ischaemia in patients at intermediate coronary risk as well as for the other indications.