Preventing ischemic heart disease (IHD) after kidney transplantation requires a comprehensive clinical strategy. Early referral and pretransplant screening for IHD may help prevent posttransplant IHD events. Perioperative β-blockade may also be effective. The management of traditional risk factors, both before and after transplantation, may include aspirin prophylaxis, cigarette abstinence, treatment of hypertension, treatment of dyslipidemias, and intensive blood glucose control. Although the risk for IHD can be reduced by minimizing the use of immunosuppressive agents that adversely affect cardiovascular risk factors, the management of risk factors must also include a strategy of optimal immunosuppression to prevent acute rejection and maximize long-term kidney function. A number of lifestyle modifications that may favorably affect cardiovascular disease risk factors should also be encouraged. In summary, a multidisciplinary approach that emphasizes evidence-based management of traditional risk factors is currently the best approach to reducing the risk for IHD after kidney transplantation.