Cardiovascular disease (CVD) has become a major clinical and public health problem. South Asian countries, namely India, Pakistan, Sri Lanka, Bangladesh and Nepal, not only represent a quarter of the world's population but also contribute to the highest proportion of CVD burden when compared with any other regions globally. This population carries the increased risk even if they migrate to other countries and have increased mortality due to CVD at a younger age in comparison to the local population. In this review, the risk factors and reasons for the higher rate of CVD in South Asians are discussed.