In Third World countries, coronary heart disease is more frequent in the upper classes. In industrial countries such as the United States, Canada and the United Kingdom, there has been a widening social class difference in the opposite direction. Yet the social class differences have been largely ignored in the development of public health programs to prevent cardiovascular disease. This paper presents specific recommendations to correct this glaring defect, including giving priority to the reduction of risk factor prevalence among low-income blue collar and white collar workers; strengthening regulatory, taxation and other measures that directly impact all classes of the population; reversing the declining living standards of large segments of the U.S. population which result from current economic and political policy; and greatly expanding the resources available for public health programs from their grossly inadequate level.