India is undergoing an epidemiological transition and is on the threshold of an epidemic of cardiovascular disease. Cause-specific mortality data indicate that cardiovascular disease is already an important contributor to mortality. Demographic projections suggest a major increase in cardiovascular disease mortality as life expectancy increases and the age structure of the growing population changes. Surveys in urban areas suggest that coronary risk factors are already widespread and that urgent action is needed to prevent a further rise as socioeconomic development proceeds. It is vital to obtain epidemiological data from several regions in order to plan, initiate and monitor public health action.