Patients with clinically evident atherosclerosis are at high risk for future cardiovascular events and mortality. Despite the compelling scientific and clinical trial evidence that preventive medications, such as acetyl salicylic acid, and hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors reduce mortality in patients with documented atherosclerosis, such life-saving therapies continue to be underused. A number of studies in a variety of clinical settings have documented that a significant proportion of patients with atherosclerotic vascular disease are not receiving treatment with appropriate preventive medications, and most distressing is the fact that many vulnerable populations and specific ethnic and gender groups are even less likely to receive adequate treatment. Recent data demonstrate that physician behavior may cause, at least in part, gender and racial differences in the treatment of cardiovascular disease. Exploring all potential factors that affect differences in cardiovascular treatment and outcomes will hopefully lead to improved understanding and treatments for all patients.