Developing countries are subject to the same risks that have contributed to the high incidence of cardiovascular diseases in the already developed countries. Improvements in life expectancy at birth lead to predictable shifts in the cause-of-death structure over time. The stage at which cardiovascular diseases may be considered to be ‘actively emerging’ corresponds to a life expectancy level between 50 and 60 years and, at this level, cardiovascular disease mortality accounts for 15–25% of all deaths. The average life expectancy at birth in developing countries for the year 2000 is projected to be 60 years or more and it may be expected that by that time cardiovascular diseases would be actively emerging or established in virtually every country. In many developing countries today, life-style pattern that is associated with high rates of coronary heart disease is not yet widespread and it is therefore logical that a strategy of prevention should include efforts to inhibit the entrenchment and spread of unhealthy life-styles in the community (i.e., primordial prevention). At the country level, cardiovascular disease prevention and control cannot be considered in isolation and must be related to prevailing national health priorities and competing claims from other sectors of development. In poorer countries where life expectancy is below 50 years primordial prevention activities are likely to be restricted – perhaps to smoking and hypertension control. In middle-income countries a broader based approach to primordial prevention is feasible and is more likely to be acceptable.