Coronary heart disease (CHD) is the leading cause of death among women in the United States, yet few studies have specifically targeted women who have CHD, and still fewer have examined how behavior and psychosocial factors affect lifestyle change. This article reviews what is known about lifestyle change, with an emphasis on psychosocial factors related to change, in women with CHD. Studies exploring individual lifestyle improvement areas--exercise, nutrition, smoking, and social support--as well as studies of comprehensive lifestyle changes are reviewed. Strong conclusions were precluded because of the paucity of studies, widely variable and inconsistent findings, flawed methodologies, and inadequate reporting of results. Future research is advised to develop and test intervention programs for women with CHD, addressing barriers to participation, lifestyle change patterns, psychosocial and quality of life outcomes, and physiologic change.