The role of gene abnormalities in the causation and modulation of cardiovascular disease is a source of intense and unabated interest. Diseases described as monogenetic— hypertrophic cardiomyopathy, long QT syndrome, familial hypercholesterolemia— are best understood, though they reveal frequent discordance between gene abnormalities and clinical phenotype. This is explained by the presence of multiple gene defects, and by gene-dose, gene-gene, and gene-environment interactions. Common conditions such as coronary artery disease, metabolic syndrome, and hypertension represent the logical conclusion to the spartan lifestyle of mankind throughout millions of years of evolution. The next 10 years will provide important insights into the “purpose” of the genes that we commonly share, which were previously beneficial, but now predispose to modern diseases...