Given the high prevalence of hypertension and diabetes, coupled with widespread poverty, neurological and cardiovascular diseases are major causes of premature mortality (under 65 years of age) in French Guiana. The objective of this study was to describe the epidemiology and indicators of hospital care in order to identify specific characteristics and areas for improvement in a department that does not yet have interventional radiology services. A prospective multicenter cohort study on stroke and health inequalities (PHRC INDIA) examined the epidemiology of stroke and care indicators between June 2011 and October 2014. Retrospective data on ST- and ST-elevation acute coronary syndromes were collected between January 2012 and December 2014. Regarding acute coronary syndromes, in-hospital mortality was 7/82 (8.5%) for ST-elevation and 4/184 (2.17%) for ST-elevation. For ST-elevation coronary syndromes, the thrombolysis rate was 17/82 (20.7%). For both ST-elevation and non-ST-elevation cases, there was a prevalence of hypertension (69.5% and 75.5%, respectively), diabetes (30.5% and 44%, respectively), a history of stroke (12.2% and 10.3%, respectively), and chronic kidney disease (11% and 15.2%, respectively) were higher than in French publications. Regarding strokes, the majority were ischemic (234/298 (78.5%)). The mean age was 61.8 years (standard deviation, SD = ±14.5), and the proportion of men was 63.5%. For ischemic events, 89/234 (38%) arrived early enough to receive thrombolysis, and 32/234 (13.6%) had received thrombolysis. The crude in-hospital mortality rate was 7.31%, but was 19.5% when adjusted for age. In conclusion, there are specific epidemiological characteristics of coronary syndromes and strokes in French Guiana. The burden of treatable risk factors is significant and should be the focus of large-scale campaigns in the hope of reducing the burden of premature mortality (before age 65) associated with cardiovascular diseases. Regarding care, the gap with mainland France is not obvious, but there appears to be room for improvement thanks to the local establishment of a neurovascular unit and an interventional radiology unit.