Diabetes is known risk factor for development of heart disease, and Pacific people are more likely to develop diabetes (11.1%) compared to Maori (7.6%) and NZ European (4.9%). Māori and Pacific patients are also carrying the heaviest burden of cardiovascular disease, requiring surgical intervention at a younger age. The question is why does this earlier manifestation of cardiovascular disease occur? We know that ageing and fibrosis are important players in detrimental changes in heart function with the ability of the heart to contract and work effectively reduced in older individuals and with increased fibrosis. Klotho is an anti-ageing protein that when this protein is low induces a variety of disorders, including increased fibrosis. Perhaps the answer is that the level of klotho is low in Pacific and Maori, which could lead to an increased level of cardiac fibrosis which could explain the early diagnosis of heart dysfunction in these cohorts.