During 1993-95, a study on 517 men and women both in the Holdsworth Memorial Hospital, Mysore, South India between 1934 and 1953, and whose weight, length and head circumference at birth had been recorded, showed that small size at birth was associated with an increased rate of CHD. I examined the hypothesis that the link between reduced fetal growth and adult CHD in this population is mediated by increased LV mass and reduced arterial compliance. In the follow-up study of 435 men and women during 1996-97, I measured systolic and diastolic blood pressures, LV mass (using 2D and M-mode echocardiography) and compliance in three arterial segments (derived from pulse wave velocity {PWV} using the non-invasive technique of photoplesythmography; higher the PWV, lower the compliance). Both LV mass and PWV in this Indian population are low compared with Western populations, though as in the West, higher LV mass is associated with an increased risk of CHD. Greater LV mass and reduced arterial compliance are associated with an adverse coronary risk profile, especially with features of the Insulin Resistance Syndrome (hypertension, raised triglycerides and lower HDL-cholesterol, non-insulin-dependent diabetes mellitus and insulin resistance, and central obesity). The higher prevalence of CHD in Indian men and women of lower birthweight, shown in an earlier study of the same cohort, cannot be explained by changes in blood pressure, LV mass or arterial compliance. The association of raised blood pressure and LV mass with longer length at birth suggests that the way in which the intrauterine environment influences CHD differs between Indian and Western populations.