Cardiovascular disease in renal transplant recipients is a major cause of graft loss and patient mortality. It is only in recent years that it has become understood that the mechanisms underlying coronary events in these patients differ from the general population. Patients with renal disease are more likely to suffer a fatal cardiovascular event than a non-fatal event and simply addressing conventional risk factors, which relate to atheromatous coronary artery disease, is insufficient in this population, where uraemic cardiomyopathy and graft specific factors uniquely increase risk. We discuss known epidemiological data relating to cardiovascular risk in these patients, consider traditional risk factors such as smoking, hypertension, diabetes and lipids, as well as graft-specific factors such as immunosuppressive therapies, and graft dysfunction. Management of cardiovascular risk in renal transplant recipients is necessarily multi-factorial but strong prospective evidence is lacking.