Coronary artery disease (CHD) is associated with industrialisation and modernisation of society. CHD was uncommon in Britain in the 19th century and when it became a major problem, the wealthy were affected more. Now CHD is the commonest cause of death and affects poorer people more. This time-trend has not been explained satisfactorily. While trends in South Asian populations remain unclear, there is some evidence of a decline in the absolute rates but an increase in the level of disparity in comparison to the whole population a result of rapidly declining rates in the white, European origin populations. The association between low social class and higher cardiovascular mortality and risk factors has emerged in South Asians CHD is still uncommon in many countries, particularly developing countries. There is a paucity of information on the frequency of CHD in the Indian subcontinent and seemingly it is uncommon in rural areas, but is a growing problem in the cities. The epidemic in South Asians abroad forewarns of what may happen on the Indian Subcontinent.