Purpose: The goal of this observational study was to examine overall and age-specific differences between women and men in the use of five beneficial cardiac medications in patients hospitalized with acute myocardial infarction (AMI) from a community-wide perspective. The objectives of our study were to determine whether women are treated differently than men and whether age acts as a potential effect modifier of any observed associations. Subjects: A total of 2,461 women and 3,454 men with validated AMI comprised the study sample. Methods: Our study was an observational investigation of metropolitan Worcester (Mass., USA) residents who were hospitalized with initial AMI in all area hospitals during 12 1-year periods between 1975 and 1999. Four age-specific subgroups (<55, 55–64, 65–74 and ≧75 years) were studied. Results: Differences in the use of angiotensin-converting enzyme (ACE) inhibitors, aspirin, β-blockers, lipid-lowering medications and thrombolytic agents during hospitalization for AMI were examined. The results of a multivariable regression analysis indicated that women were significantly less likely to receive aspirin and ACE inhibitors as compared to men. There were no significant gender differences in the prescribing of the other cardiac medications. Increasing age in both women and men was associated with a reduced likelihood of receiving effective cardiac therapies including aspirin, β-blockers, lipid-lowering therapy and thrombolytic agents. Conclusions: These data suggest that the reasons for the marked age-related differences, in men and women, in the use of cardiac medications be more systematically explored. Previously observed gender differences in the management of patients with AMI essentially no longer exist.