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The global trends in disease specific mortalities indicate that ischemic heart disease (IHD) is the leading cause of death in age group ≥60 years. It is also being recognized that cardiovascular diseases (CVDs) and their risk factors are emerging as primary health problems in India with all socioeconomic groups being equally vulnerable. Though the high mortality rates due to CVDs in India may have major economic repercussions, the analysis on economic impact of CVDs remains incomplete, because of inadequate coverage of these diseases in India's vital event registration and absence of surveillance systems for disease specific mortality data. The per capita expenditure on health by public sector is very low making the poor to go for costly private healthcare facilities. We discuss here the burden of CAD and its risk factors in India and need for using population and individual based prevention strategies to halt and reverse the CVD epidemic. The country will need to create data for technical and operational factors for making prevention and control of CVDs feasible. National and international multidisciplinary collaborations will be needed to address the challenge posed by CVDs.