Epidemiologic transition is associated with development and involves the process by which the pattern of mortality and disease shift. It is often characterized by a shift in communicable diseases and nutritional deficiencies to chronic diseases (non-communicable diseases (NCDs)). For example, a transformation from high infant and child mortality, episodic famine, and pre-transitional diseases related to infections to one of degenerative and chronic diseases (post-transitional diseases such as those attributed to diet, sedentary lifestyle, medical access, smoking and other behaviors i.e. cardiovascular disease (CVD), cancer, chronic lung disease and diabetes) [1–4]. According to World Health Organization (WHO) estimates, about 60% of deaths in the world are now caused by non-communicable diseases (WHO, 2002). In 2005, an estimated 17.5 million people died of CVD representing 30% of all global deaths of which 80% were from low- and middle-income countries (WHO, 2007). By 2020, studies indicate that mortality by CVD is expected to increase by 120% for women and 137% for men . These findings highlight the need to explore the nature and magnitude of CVDs and other non-communicable diseases in developing countries.
Sub-Saharan Africa (SSA), consisting of those countries that are fully or partially located south of the Sahara Desert, are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors , which in turn have raised the incidence of NCDs, especially CVD . Studies indicate that urbanization and economic development have also led to the emergence of a nutritional transition characterized by a shift to a higher caloric content diet and/or reduction of physical activity . Together, these transitions create enormous public health challenges, and failure to address the problem may impose significant burden for the health sector and the economy of sub-Saharan African countries 
In countries such as Nigeria, Ghana and South Africa, the prevalence of chronic diseases is increasing, while the threat of communicable and poverty-related diseases (malaria, infant mortality, cholera, malnutrition) still exists [5, 7, 9, 10]. In South Africa, CVD is the second leading cause of death after HIV accounting for up to 40% of deaths among adults .
This double burden of communicable and chronic NCDs has long-term public health impact as it undermines healthcare systems . Sub-Saharan African countries, similar to most developing countries, often do not have the public health infrastructure and finances to address both communicable and poverty-related illness and behavior/chronic related illnesses . In addition, there is reluctance on the part of health funding agencies and policy makers to divert scarce resources away from communicable diseases into other areas of disease burden, such as NCDs [9, 12]. However throughout SSA, NCDs such as CVD are anticipated to soon eclipse communicable and poverty-related diseases as the leading cause of mortality and disability [13, 14]. Also, evidence suggests that the increasing burden of chronic diseases has grave consequences because very few people will seek treatment, leading to high morbidity and mortality rates from potentially preventable diseases .
Globally, including SSA, certain risk factors have been found to account for up to 90%, of myocardial infarctions and other poor CVD outcomes such as stroke. These risk factors include smoking, alcohol consumption, obesity, diet, low physical activity, psychosocial factors, diabetes, hypertension and high lipid levels. .
The purpose of this paper is to explore the socio-cultural context of CVD risk prevention and treatment in SSA. We discuss risk factors specific to the sub-Saharan African context, including poverty, urbanization, developing healthcare systems, traditional healing, lifestyle and socio-cultural factors. We then present an African-centered cultural model which can be employed as an organizing framework and problem solving tool for culturally relevant interventions and programs to reduce CVD risk in SSA.