This publication presents a comprehensive overview of cardiovascular disease (CVD) as a public health problem in developing countries, the relative role of nuclear cardiology methods within a scenario of unprecedented technological advances and the evidence behind recommendations. The potential role of non-invasive functional imaging in the diagnosis of obstructive coronary artery disease and more widely in defining the global burden of CVD is also discussed, as well as the need for training, education and quality assurance in nuclear cardiology practice.