Acute cardiovascular diseases (CVD) are the main natural causes of death in industrialized countries - both at sea and on land. Seafarers face very specific job-related cardiac risk factors, such as time pressure, long working hours, or high stress factors onboard [1, 2]. Taking into consideration the healthy worker effect of seafarers, cardiac risk factors are shown to occur slightly more frequently in seafarers than in the general population. Owing to the lack of health professionals onboard and the limited treatment options of events at sea, effective cardiopulmonary resuscitation is often delayed and the outcome of cardiac events may be worse compared to that in other occupations ashore. Seafarers' medical surveillance examinations should be used more intensively as an opportunity for education of crews in CVD risks and the possibilities to reduce them. Further, enhancement of treatment options (e.g. by implementation of advanced therapy and diagnostics such as telemedicine or AED onboard) may contribute to improved CVD prognosis at sea.