Cardiovascular disease represents the prime cause of mortality and morbidity in many countries. The occurrence is affected by pre-existing risk factors of which the best known at the moment are the environmental risk factors. However, for the same level of environmental risk, two individuals do not necessarily have the same probabilities of developing a cardiovascular event. In effect, the constitutional component, accounted for by details in everyone's genetic makeup, can significantly alter this risk. The characterisation and identification of the mutations responsible for this variation in individual susceptibility are complex in the case of multifactorial diseases such as cardiovascular disease. Several studies now allow a glimpse at the expected benefits of understanding this genetic component, as far as diagnosis, prognosis and pharmacogenetics are concerned. The current explosion in high capacity genome techniques will herald new therapeutic approaches likely to further improve the survival and quality of life for our patients.