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For years, it has been recognized that the incidence of coronary heart disease (CHD) in women lags behind that of men by≈ 10 years, 7 thus generating hypotheses that differences in endogenous sex steroid levels contribute to sex differences in CHD. It also has been recognized for years that DM confers greater risk for CHD death in women compared with men. 8 Early Rancho Bernardo Study publications noted that men with DM by history or by fasting plasma glucose had a 2.4-fold excess risk of ischemic heart disease death compared with men without DM, whereas women who had DM had a 3.5-fold excess risk compared with women without DM that was independent of multiple covariates (P= 0.048 for effect modification by sex). 9 As they age, women with DM eventually have a risk of CHD death similar to that of men with DM. 8 Therefore, is it possible that differences in endogenous sex steroids contribute to …