The most striking feature of the management of patients with cardiovascular disease (CVD) in India, is its heterogeneity: from patients treated at tertiary and teaching hospitals, who receive the best possible evidence-based care, to patients who have poor or, even no, access to specialist care and whose condition, therefore, is poorly treated. The challenge for Indian healthcare lies in righting this imbalance. One step in this direction would be to document practice patterns in representative treating hospitals in different regions of the country, to identify the strengths and weaknesses of the system. Resource-sensitive guidelines incorporating evidence-based, cost-effective treatments should be widely disseminated. Large-scale efforts to improve general awareness about CVD and its risk factors, and to promote healthy lifestyles, should be undertaken, and the consumption of tobacco products and unhealthy foods discouraged.