As the cardiovascular disease (CVD) epidemic ebbs from the Western countries its impact shift towards developing nations. CVD has already emerged as the leading cause of mortality in India and other developing countries. However, the knowledge in CVD prevention gained from the West provides an opportunity to reduce the morbidity and mortality due to these diseases. The stress needs to be on the implementation of current knowledge and to eliminate barriers at various levels in CVD prevention. This article discusses the role of high risk-strategy for CVD prevention, the hurdles in its implementation, and how to overcome them.