Asian Indians constitute almost one-fifth of the world population. A high prevalence of cardiovascular disease (CVD) and diabetes has been observed in this ethnic group in most of the studies conducted worldwide. It has been documented that migrant Indians have 3-4 times higher risk for CVD compared with Caucasians, 6 times higher than Chinese and 20 times higher than Japanese. Further, the incidence of CVD appears to be rising at an alarming rate in the Indian population in contrast to the decrease in incidence occurring in the developed countries. This predilection to CVD among Indians has been attributed to the so called “Asian Indian or South Asian Phenotype” which comprises of increased central obesity despite lower body mass index, increased insulin resistance, a characteristic dyslipdemia with low HDL-C (High Density Lipoprotein Cholesterol), increased triglycerides and excess of small dense LDL-C (Low Density Lipoprotein Cholesterol), decreased adiponectin and increased high sensitivity C-reactive protein levels. Clustering of metabolic abnormalities and high prevalence of metabolic syndrome and diabetes has also been reported among Indians. This review discusses the role of several vascular risk factors in contributing to the excess of CVD in Asian Indians with a focus on some of the recent studies from the Indian subcontinent.