Ischaemic heart disease and stroke are among the most common causes of death and disability in the world. The Indian subcontinent (including India, Pakistan, Bangladesh, Sri Lanka, and Nepal) has among the highest rates of cardiovascular disease (CVD) globally. Previous reports have highlighted the high CVD rates among South Asian immigrants living in Western countries, but the enormous CVD burden within the Indian subcontinent itself has been underemphasized. In this review, we discuss the existing data on the prevalence of CVD and its risk factors in the Indian subcontinent. We also review recent evidence indicating that the burden of coronary heart disease in the Indian subcontinent is largely explained on the basis of traditional risk factors, which challenges the common thinking that South Asian ethnicity per se is a strong independent risk factor for coronary heart disease. Finally, we suggest measures to implement in policy, capacity building, and research to address the CVD epidemic in the Indian subcontinent.