A debate has emerged as to what should be the 'appropriate' cardiovascular agenda for sub-Saharan Africa. This Clinical Advance article reviews a recent study by Sliwa et al., which describes patients with newly diagnosed cardiovascular disease (CVD) presenting to a tertiary-care center in South Africa. The most common conditions among these patients were hypertension, heart failure, valvular heart disease, and coronary artery disease. Atherosclerotic risk factors were widely prevalent--only 13% of patients had no risk factors at all. Furthermore, a substantial proportion of patients presented at an advanced stage of disease. This study, which used state-of-the-art diagnostic technology, is an important addition to the growing database of information indicating that CVD in sub-Saharan Africa spans the spectrum from 'traditional', nonischemic etiologies to 'modern' diseases of lifestyle. The societal response to this diverse epidemiology should be similarly multifaceted. Moreover, efforts should be made to improve primary-care screening, early detection and treatment of CVD, and prompt referral of patients at early stages of disease.