BACKGROUND.: Asian Indian migrants in the Western world are highly susceptible for ischaemic heart disease (IHD). Until now, most IHD risk studies were performed in first and second generation Asian Indian expatriates. For optimal prevention, knowledge of the cardiovascular risk profile of younger generations is crucial. METHOD.: In a cross-sectional study we assessed the prevalence of conventional IHD risk factors and Framingham risk score in asymptomatic third to seventh generation Asian Indian descendants, compared with Europeans. Subjects were classified as asymptomatic if they did not have documented IHD, diabetes, hypertension or high cholesterol. RESULTS.: A total of 1790 Asian Indians (45% men, age 35.9+/-10.7 years) and 370 native Dutch hospital employees (23% men, age 40.8+/-10.1 years) were recruited. Asian Indians had higher levels of total cholesterol, low-density lipoprotein, triglycerides, and lower high-density lipoprotein levels than the Dutch. Glucose intolerance was present in 7.1 vs. 0.5% men, and in 6.1 vs. 1.4% women (both p<0.001). Asian Indian women were more frequently obese (12 vs. 5%; p<0.001), and centrally obese (44 vs. 25%; p<0.001) as compared with the Dutch women. Prevalence of most of the conventional and modifiable cardiovascular risk factors in each ten-year age group was higher in Asian Indians compared with controls, which reflected in higher Framingham risk scores. CONCLUSION.: This study demonstrates the persistence of an unfavourable cardiovascular risk profile in young, third to seventh generation migrated Asian Indians and supports an aggressive screening and intervention strategy. (Neth Heart J 2009;17:155-61.).