Cardiovascular diseases are highly preventable, yet they remain the most common cause of death in the world. The epidemic is receding in industrialized countries; however, many low-income and middle-income countries have experienced an increase in cardiovascular diseases and 80% of all cardiovascular diseases deaths occur there. In the last 20 years, the epidemiology and surveillance of cardiovascular diseases have laid the foundations for public health interventions that may reduce the burden of disease. Relevant population-specific local data are therefore needed to describe the trends and pattern of risk for atherosclerotic diseases. Once the basis for surveillance and epidemiological research has been laid, cardiovascular disease prevention will require approaches adapted for each individual and population. The existence of effective preventive interventions justifies the assertion that coronary heart disease and stroke could be virtually prevented and controlled. Our goal in this review is to summarize the current challenges and opportunities for cardiovascular medicine, focusing on the need for high-quality local surveillance systems that provide the appropriate data needed to develop sound national cardiovascular disease preventive policies.