During more than 50 years the high cardiovascular risk in Eastern Europe and former Soviet Union, now Russia, has been described as very high. This is based on epidemiological findings from countries and regions, for example within the MONICA study as organized by the WHO. One common explanation is that this is influenced by an adverse cardiovascular risk factor profile including high prevalence rates of hypertension in many subjects, in combination with unhealthy lifestyle (smoking, alcohol, diet) and stressful social conditions, including health care gaps. Even if this could explain a substantial proportion of the increased risk, it is not enough for a full understanding. If a so called life course perspective is applied this means that also factor in early life should be taken into account and the time-dependent context when people were born, so called birth cohort effects, for programing and lasting effects on the individual, i.e., via epigenetics. It is a historical fact that many adverse social factors, as well as war and human suffering, was prevalent in the 1930’ies and 1940’ies for a large part of these populations. Other studies have shown that this could influence programming of health and disease already during fetal life and early childhood. In this presentation the epidemiological trends of cardiovascular disease and risk factors in Eastern Europe and Russia will be put in perspective of the historical and social transition that has occurred in these countries and populations. A broader perspective could teach us new aspects of the origin of cardiovascular disease and that public health measures are of importance, as currently studied in the HAPPIEE Study based on Anglo-Russian research collaboration . This could inspire new research agendas and how treatment of cardiovascular risk does not only involve the individual but whole communities.