An evolving epidemic of cardiovascular disease (CVD) is having a profound effect on the health of vulnerable populations in low-to-middle income countries with limited resources. Despite some encouraging signs (particularly initiatives from the WHO), global and regional apathy towards noncommunicable forms of CVD adds to the complexity of issues to consider when establishing cost-effective prevention programs. We present our perspective on overcoming the myriad of barriers to providing cost-effective measures for CVD prevention in a resource-poor environment through the 'prism' of our experiences in establishing the Heart of Soweto Study in South Africa.