Amongst the non-communicable diseases (NCDs), cardiovascular disease (CVD) is the most common cause of death. According to the WHO, nearly one-third of all deaths in 2008 were due to CVD, with 80% of these occurring in low- to middle-income countries. How do early life factors modulate the risk of CVD? Dr. Atul Singhal explores the main risk factors for CVD, revealing that those occurring in early life are the most influential. In covering the growing body of evidence that supports the theory of the fetal origins of adult disease, Singhal highlights the importance of birth weight and early growth patterns in modulating long-term risk of CVD. Early life factors act alongside sedentary lifestyles and energy-rich diets to exacerbate this risk, a problem which is particularly relevant to low- and middle-income countries. In these populations, it is especially important to target pre-pregnancy and maternal nutrition, prevent small for gestational age births, and promote breastfeeding. Singhal concludes by discussing the relevance of these findings and providing a series of recommendations to curb the global epidemic of CVD.