The goal of this Center of Excellence project is to establish a sustainable continuous quality improvement environment in western Kenya to cyclically evaluate how to diagnose, characterize, treat and prevent chronic cardiovascular and pulmonary diseases. Objectives for this project are to 1. organize an administrative core for CVD clinical care, training and research; 2. develop and implement a competency-based clinical training curriculum; 3. establish a clinical research training program; 4. adopt and enhance existing data management and laboratory infrastructure for CVD; and 5. implement research programs to address prevalence, prevention and treatment.