Evidence of the benefits of lowering cholesterol in various populations continues to grow, but questions persist about screening and treatment of lipid disorders in women. In this paper, we review the distinct features of the epidemiology of lipids and coronary heart disease in women and data from recent long-term treatment trials specific to women. Although data from primary prevention trials in women remain sparse, recent trials demonstrating benefits of cholesterol reduction across a broad range of cholesterol levels and cardiac risk in men and women bolster the conclusion that benefits may extend to asymptomatic women who are otherwise at high risk for coronary disease. Periodic lipid screening beginning in middle age will identify most women who are at high enough risk to merit drug therapy or more intensive individual lifestyle interventions. More detailed consideration of age, diabetes, blood pressure, specific lipid levels, or the ratio of total cholesterol to high-density lipoprotein cholesterol, and other risk factors can more accurately estimate individual risk of coronary heart disease and identify high-risk women most likely to benefit from lipid reduction. Advice about healthy diet, weight control, and physical activity can benefit all women, but authorities differ on the benefits of routine lipid screening in low-risk younger women.