Cardiovascular disease is one of the major causes of death among native Americans. Ischemic heart disease has been relatively uncommon in the past, but this entity is rapidly becoming more frequent among Indians as a result of Western acculturation (Western high-fat diet, smoking, sedentary lifestyle). Hypertension remains a major problem in native American populations. Hypertension is often inadequately detected and treated in Indians. Rheumatic fever and rheumatic heart disease are moderately common and apparently in decline among native Americans. Finally, the fetal alcohol syndrome with its accompanying cardiac malformations is all too common among North American Indians. The amount of information available concerning cardiovascular disease in native Americans is rather small. Considerably more attention should be paid to this area in the future.