The looming threat posed by the emergence of cardiovascular disease (CVD) in sub-Saharan Africa (sSA) is underestimated and often denied. The health services and societies struggle to cope with the direct effects of poverty, war, fragile social and economic structures and AIDS. The threat of CVD seems less direct and few reliable data are available. This has resulted in neglecting serious warning signs on the emergence of CVD in sSA. This short review deals with the strong increase in a number of risk factors for CVD in certain areas, necessitating preventive measures to lighten the 'double burden of disease' in this part of the world.