Coronary Heart Disease (CHD) is one of the leading causes of death globally. The Pacific Island Countries (PICs) including Fiji is facing a CHD crisis. Therefore, this study aimed to determine the risk factors, initiatives, services provided, and strategies of CHD prevention to provide recommendations for Fiji. The systematic review gathered studies from 4 electronic databases including Medline, Embase, Web of Science, and CINAHL that were published within the period of 2007 to 2017. The secondary data was also collected from the Fiji Ministry of Health and Medical Services (MoHMS), the World Health Organisation (WHO), and other health organisations reports and plans. All studies were scanned and reviewed by 2 independent researchers using Covidence automation tool. Duplicate studies were omitted and the abstracts of remaining studies were read. Additional abstracts were excluded as they were irrelevant and the full text of remaining studies were read for further analysis. Twenty-one studies met the study criteria from which data were extracted and analysed to identify themes. The results showed that majority of studies were conducted beyond 2015. Four themes were identified including better healthcare services delivery, initiatives and interventions for CHD, risk factors to CHD, and enforcement of health policies. This study highlighted the importance of reviewing current polices, health services, and preventive strategies in controlling CHD among Fijians. Providing tailored interventions using health promotion approaches by considering the risk factors of CHD is highly recommended.