Cardiovascular disease is the leading cause of death in those over the age of 45 in Africa. The economic toll from cardiovascular diseases is equally devastating, leading to billions of dollars lost due to healthcare costs and reduced productivity from the disabling and fatal outcomes related to diabetes, hypertension, stroke, valvular heart disease, and heart failure. Much of it is preventable. With reasonable screening programmes and judicious use of scarce resources much of the suffering can be alleviated. This article reviews the economic burden attributable to cardiovascular disease in Africa and many of the potential cost-effective solutions to the large burden. It further outlines many of the areas where we know less and must focus our future research in trying to outline cost-effective solutions.