The spectrum of cardiovascular diseases varies between countries. Data from east Africa is scarce, but important in formulating disease management strategies. The aim of this study was to describe the spectrum of cardiovascular causes of death in Kenya. One hundred and thirty four autopsy cases of cardiovascular related deaths examined at the Department of Human Anatomy, University of Nairobi, from December 2005 to November 2009 were analyzed for disease type, age and gender distribution. Only cases in which cardiovascular disease was the most likely cause of death were included. Data was analyzed using SPSS version 15.0 for Windows and presented using tables and bar graphs. Cardiovascular causes comprised 13.2% of all autopsy cases. Common conditions included myocardial infarction (18.7%), cardiomyopathy (17.2%), subarachnoid hemorrhage (15.7%), pulmonary thromboembolism (14.2%), ruptured aortic aneurysm (11.2%) and hypertensive heart disease (9.0%). Infective pericarditis and rheumatic heart disease comprised 7.5% and 6.7%, respectively. Mean age was 50.4 years, peaking at 40-60 years, with 56.7% aged 50 years and younger. Male: female ratio was 2.7:1. Cardiovascular disease contributes more than 13% of overall mortality in Kenya. Myocardial infarction is the commonest, while rheumatic heart disease is the rarest. It is predominantly male and mainly affects those aged under 50 years. This suggests that non-communicable diseases, while predominant, overlap with infectious conditions as causes of cardiovascular mortality. A search for, and the prevention of, risk factors, combined with prudent management of infection, are recommended.