Cardiovascular disease (CVD) is the leading cause of death among renal transplant recipients with a functioning transplant. The prevalence and severity of CVD in renal transplant recipients are related to numerous factors, most shared with the general population and others specific to transplant recipients, including effects of kidney dysfunction and immunosuppressive drugs. Modern immunosuppressive regimens have allowed a decrease in the dose of corticosteroids, which markedly increase cardiovascular risk. However, each of the 3 agents commonly used as the base for immunosuppressive regimens, cyclosporine, tacrolimus, and sirolimus, may contribute significantly to 1 or more cardiovascular risk factors that are already of substantial concern in this population. Cyclosporine has been associated with the greatest hypertensive effect; tacrolimus, with the greatest impact on diabetes and glycemic control; and sirolimus, with the greatest impact on lipid profiles. This review highlights the major causes of CVD in renal transplant recipients, with particular attention to hypertension, diabetes, and dyslipidemia, and evaluates the contribution of immunosuppressive agents to cardiovascular risk.