Cardiovascular disease prevention is most effective when it is tailored for individual risk, since the benefit of any preventive intervention should outweigh its potential side effects and costs. Recognition of important gender differences in cardiovascular disease prevention has led to the formulation of specific guidelines for women. Based on a rigorous review of evidence, the 2007 American Heart Association guidelines for cardiovascular disease prevention in women differ little from the guidelines for men. The main difference pertains to the role of aspirin in primary cardiovascular prevention and to the appreciation of diabetes as a more detrimental risk factor in women than men. These guidelines provide a valuable framework to select the optimal preventive strategy for women of all ages, based on individual risk stratification, potentially supplemented with appropriate use of novel imaging modalities. Observational data continue to identify discrepancies between women and men, which target areas of need for future research.