Cardiovascular disease has for many years been considered a lifestyle disease, caused by westernisation or modernisation. The most important lifestyle risk factors are thought to be diet (particularly high levels of saturated fats and excess salt), lack of physical activity, obesity, psychosocial stress and smoking, all of which are identified with modern living in industrial societies. This paradigm goes some way towards explaining observed inter-and intrapopulation variation in the prevalence of cardiovascular disease, but does not explain all such variation. It is important that physical anthropologists start considering new hypotheses concerning quite different risk factors. It has been suggested that undernutrition in fetal and early infant life may program physiological systems such that later exposure to lifestyle risk factors are particularly dangerous. A quite different theory links infection with certain bacteria, and perhaps viruses, to increased risk of cardiovascular disease. Both these proposed risk factors are much more prevalent in developing countries and poorer populations, although they may only become important when well-known risk factors are introduced too. The possible protective role of estrogen in women and the light which anthropologists' work on ovarian function throws on its potential for impact in different populations are also discussed. Future attempts to explain variation in cardiovascular disease risk will require a new complexity of approach. It will be particularly interesting to consider the interaction between maternal and infant undernutrition, infectious disease load, hormonal changes and cardiovascular disease in modernising populations. Anthropologists are well placed to undertake such investigations. Yrbk Phys Anthropol 40:1-24, 1997.