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South Asians have higher rates of cardiovascular disease than Europeans. Co-morbidities (hypertension, type 2 diabetes and dyslipidaemia) also occur more frequently. Left ventricular hypertrophy and dysfunction are features of these disorders and predict a high risk of heart failure and death. There are very limited data on the prevalence, determinants and prognosis of these myocardial abnormalities in South Asians. The New Delhi and Vellore cohorts in India (N=3744) have detailed data on size at birth, childhood growth, and cardiovascular risk markers and lifestyle in young adulthood. Lower weight at birth or in early childhood was associated with a higher risk of adult diabetes, while rapid gain in adiposity in late childhood was associated with hypertension, diabetes, dyslipidaemia and inflammatory markers. These findings suggest an early life contribution to cardiovascular risk. However, early growth was unrelated to arterial health (carotid intima media thickness and brachial endothelial function). Cohort members are now aged 45 years. We plan to measure their left ventricular structure and function using echocardiography, to generate unique information on lifecourse predictors of myocardial abnormalities, including early growth and young adult metabolic and lifestyle factors. We will also set up systems to monitor future cardiac events and deaths. Our aim is to explore opportunities for the primary prevention of cardiac failure and death.