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In Africa, coronary heart disease (CHD) is near absent in rural areas, and very uncommon in urban centres, where many Africans are in an advanced stage of transition. Among town dwellers intakes of food, especially fat, have risen and intakes of fibre-containing foods have fallen. Mean serum cholesterol level is almost double that of rural populations living traditionally. Obesity in females has risen enormously. Prevalence of hypertension exceeds that in the white population. The same applies to the practice of smoking in males, but not in females. The level of physical activity has fallen generally. With these increases in risk factors we can expect urban Africans to attain the high mortality rate for CHD now experienced by Afro-Americans. Prevention by urging reversion to previous life-style behaviour is a non-starter. However, as long as Africa remains impoverished, a major rise in CHD is unlikely.