The incidence of cardiovascular disease is high after renal transplantation. Risk factors include pretransplant cardiovascular disease, diabetes, male sex, serum cholesterol, hypertension, cigarette smoking, and allograft dysfunction. Prevention of cardiovascular disease can probably best be approached by modifying multiple risk factors. Thus, efforts should be made to identify and treat patients with severe coronary artery disease before transplantation. After transplantation, hypertension and hyperlipidemia should be treated, and efforts should be made to help patients abstain from smoking. Chronic immunosuppression protocols should attempt to balance the need to prevent allograft rejection with the known adverse effects of immunosuppressive agents on cardiovascular disease. Altogether, an aggressive, coordinated program to modify multiple risk factors is probably the best approach to the prevention of cardiovascular disease after renal transplantation.