According to most studies, persons living or being born at higher altitude have a lower risk of fatal myocardial infarction or stroke than lowlanders. The altitude effect is more pronounced for myocardial infarction than for stroke and generally stronger in men than in women. Possibly, exposure to a certain altitude impacts on cardiovascular risk for the entire life span. It is unlikely that classical cardiovascular risk factors substantially influence the altitude effect. In contrast, environmental conditions that depend on altitude could play a role.