Indians have a higher propensity of developing cardiovascular disease (CVD), experience CVD at a younger age, have a higher case fatality rate, and premature mortality resulting in economic detriment. It is understood that the social determinants of health operate at a broader level and are responsible for shaping an individuals’ health behavior and choices that contribute to CVD. While in developed countries the low socioeconomic group experiences higher morbidity and mortality, in India, there has been a shift over time where initially, CVD was more common among wealthier sections, but lower socioeconomic groups are becoming more vulnerable as the transition progresses. This underscores the importance of understanding the social patterning of CVD, its risk factors, and challenges in CVD management to better guide the design and implementation of contextually relevant interventions in a resource-constrained health system.