Compared to other cultural groups, the risk of coronary artery disease in this population is amplified by two to twenty fold. For this reason, elevated total homocysteine levels, known as hyperhomocysteinemia, have been discovered to be atherogenic. In a causal, dose-related mechanism, homocysteine increases thrombotic activity and causes oxidative damage to the endothelium. Although there are both nutritional and genetic causes of hyperhomocysteinemia, studies have concluded that amongst Asian Indians deficiencies in folate and cobalamin are the primary factors. Although native Indians have an insufficient intake of folic acid and cobalamin, migrant Asian Indians are deficient only in cobalamin. The principal cause of folic acid and cobalamin deficiency is the vegetarian diet consumed by a large proportion of Indians, but it is also due to cooking methods, malabsorption, gastrointestinal disorders, and intestinal bacterial composition. The need to decrease the rising incidence of coronary artery disease offers a significant reason for the issues of folic acid fortification and multivitamin therapy to take priority in the Indian public health agenda.