OBJECTIVES: To examine the association between patterns of cardiovascular medication use and health-related quality of life (HRQoL) in elderly Australian women with diabetes. METHODS: A cross-sectional study was conducted using older cohort completing Survey 4 in the Australian Longitudinal Study on Women's Health (ALSWH) who self-reported to have been diagnosed with diabetes and/or use medications indicative of diabetes. Use of cardiovascular medications was identified from self-reported medications belonging to the Anatomical Therapeutic Chemical (ATC) code B01AC, C03, C07, C08, C09, C02 and C10. Usage patterns were classified as no use, using any hypertensives, lipid lowering agents or antiplatelet drugs, using any two classes, and using all the three classes. The SF-36 was used to measure HRQoL, focusing on the physical functioning (PF), general health (GH), vitality (VT) and mental health (MH) subscales. Multiple linear regressions were used to assess the association between usage patterns, HRQoL scores and other sociodemographic, health behaviour and health service utilisation characteristics. RESULTS: Of 7158 women retained at Survey 4, 885 were identified as having diabetes with overall prevalence of cardiovascular medication use of 89.9%. After adjusting for other covariates, being on three classes of cardiovascular medications was significantly associated with increased scores on PF (coefficient 16.134, 95% CI 6.940-25.327), GH (10.058, 95% CI 2.649-17.468) and MH (12.896, 95% CI 6.562-15.882) subscales. Being on any two classes was associated with increased scores on PF and GH (coefficient 14.744, 95% CI 5.988-23.501 and 8.334, 95% CI 1.200-15.467, respectively), whereas using single cardiovascular drug was only significantly associated with increased scores on PF (coefficient 12.346, 95% CI 3.943-20.750). CONCLUSIONS: Intensive use of cardiovasular medications to support diabetes management was shown to be subjectively beneficial. Concern about perceived deterioration on HRQoL attributable to pill burden might be captured if a diabetes-specific instrument was employed.