and Nepal account for about a quarter of the world's population and contribute the highest proportion of the burden of cardiovascular diseases compared with any other region globally. [1][2][3] South Asian migrants living in several countries have higher death rates from coronary heart disease (CHD) at younger ages compared with the local population despite apparently lower levels of conventional risk factors. [4][5][6][7][8] Deaths related to cardiovascular disease also occur 5 to 10 years earlier in South Asian countries than they do in Western countries. 9,10 This has raised the possibility that South Asians exhibit a special susceptibility for acute myocardial infarction (AMI) that is not explained by traditional risk factors.Among individuals living in the United Kingdom,theearlieronsetofCHDamong

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Shah Ebrahim and colleagues examine the distribution of obesity, diabetes, and other cardiovascular risk factors among urban migrant factory workers in India, together with their rural siblings. The investigators identify patterns of change of cardiovascular risk factors associated with urban migration.

Cardiovascular diseases are major causes of mortality and disease in the Indian subcontinent, causing more than 25% of deaths. It has been predicted that these diseases will increase rapidly in India and this country will be host to more than half the cases of heart disease in the world within the next 15 years. Coronary heart disease and stroke have increased in both urban and rural areas. Case-control studies indicate that tobacco use, obesity with high waist:hip ratio, high blood pressure, high LDL cholesterol, low HDL cholesterol, abnormal apolipoprotein A-1:B ratio, diabetes, low consumption of fruits and vegetables, sedentary lifestyles and psychosocial stress are important determinants of cardiovascular diseases in India. These risk factors have increased substantially over the past 50 years and to control further escalation it is important to prevent them. National interventions such as increasing tobacco taxes, labelling unhealthy foods and trans fats, reduction of salt in processed foods and better urban design to promote physical activity may have a wide short-term impact.