Coronary heart disease is less common in premenopausal women compared to age-matched men. This difference disappears in the post-fertile years, and is presumably related to the reduced levels of female sex hormones, with subsequent metabolic and hemodynamic modifications. Ovarian exhaustion induces a more atherogenic lipid profile, which may partly explain the increased risk of cardiovascular disease observed in post-fertile women as compared to age-matched fertile women. After the menopause, the combination of aging and estrogen deficiency negatively affects glucose metabolism. Diabetes mellitus blunts the beneficial condition associated with the female gender; furthermore, it increases the incidence of myocardial infarction, claudication and stroke in women more than in men. Finally, the unfavorable effects of menopause on the coronary risk seem to be mediated partly by changes in clotting and fibrinolytic factors.