The purpose of this review is to provide an overview of the role of dietary carbohydrates in the etiology of cardiovascular disease (CVD) among women. Many factors are thought to affect insulin resistance, and little is known about the role of diet. Through effects on post-prandial glucose and insulin, dietary glycemic load may have an important role in the insulin resistance syndrome (IRS). Dietary fiber, through its influence on the glycemic load or through other pathways, may also have important effects on this syndrome. Many short-term experimental studies have supported these hypotheses. Interestingly, associations may be stronger among overweight individuals than among nonoverweight individuals. Similar to findings for fruits and vegetables, whole grain intake has been found to be consistently associated with a reduction in risk of coronary heart disease (CHD) among both men and women. Several large randomized trials of primary and secondary prevention to date have demonstrated the efficacy of diets based on an abundance of plant foods and, therefore, high carbohydrate quality. The recommendations to follow a diet including an abundance of fiber-rich foods in order to prevent CVD and diabetes are based on a wealth of consistent scientific evidence. More long-term controlled trials are-needed to improve our understanding of efficacy and mechanisms. Women and a variety of racial/ethnic groups should be represented in these studies whenever possible.