A timely, evidence-informed call for earlier recognition, prevention, and treatment of cardiovascular disease among Indians and other South Asians.                                         Review by Dr. M. P. Ravindra Nathan

A persistent cardiovascular disparityCardiovascular disease remains the foremost cause of death worldwide despite the extraordinary advances made in its prevention, diagnosis, and treatment. Yet, within this global epidemic lies a particularly troubling paradox: people of Indian and South Asian origin continue to experience coronary artery disease (CAD)  at an earlier age and, in many instances, with greater severity than many other populations.

The burden is not confined to India. It extends to Indians and other South Asians living throughout the world. In India, CAD  and stroke have increased in both urban and rural populations, and the future trajectory remains deeply concerning.

A lifelong scientific mission

Treatise on Heart Disease in Indians addresses this important and long-overlooked disparity. The book is the culmination of Dr. Enas's decades-long clinical observation, research, and advocacy. Beginning in the 1970s, while practicing in Chicago, he observed young Indian physicians developing serious CAD despite having few conventional risk factors.

This led to a lifelong investigation into the distinctive cardiovascular risk of Indians. Through his work with AKMG (Association of Kerala Medical Graduates) and AAPI  (American Association of Physicians of Indian Origin), and the establishment of the CADI 

Research Foundation, he helped bring greater scientific attention to this problem. Dr. Enas also collaborated with world-renowned researchers including Drs: Salim Yusuf, Jeremiah Stamler, and Michael Davidson. Dr. Enas then teamed up with Dr. Basil Varkey, who's meticulous attention to detail has contributed greatly to the clarity, coherence, and readability of every chapter.

Distinctive risk and early disease

The book highlights several important messages: CAD can occur early, may be extensive and clinically aggressive, can remain silent until a catastrophic event occurs, and may begin developing much earlier in life than in other populations. Particular emphasis is placed on atherogenic lipoproteins, especially LDL cholesterol and Lp(a), with a dedicated chapter on each, underscoring their importance in the prevention of premature cardiovascular disease. CAD can occur early, may be extensive and clinically aggressive, and can remain silent until a catastrophic event occurs.

Comprehensive and practical

Across 17 chapters, the book provides a comprehensive review of the risk factors, prevention, and treatment of CAD. It covers established therapies such as statins, emerging non-statin treatments, and related cardiovascular conditions, including heart attack, angina, atrial fibrillation, stroke, metabolic syndrome, and heart failure. Three chapters are devoted to prevention, including diet and the Life's Essential 8 framework for promoting cardiovascular health.

Clear, precise, and accessible

A major strength of the book is its concise, precise, and lucid presentation, supported by current and well-selected references. Clear illustrations, graphs, and tables make complex concepts easy to understand without compromising scientific depth. The book is valuable not only for cardiologists and other physicians caring for South Asian patients, but also for patients and families seeking to understand and prevent premature heart disease.

Prevention cannot wait

CAD has now become highly preventable and treatable. The United States and many other countries have witnessed remarkable reductions in age-standardized mortality from heart disease over the past several decades, largely as a result of advances in prevention, risk-factor modification, early detection, and effective treatment. This book provides essential knowledge and practical guidance for policymakers, physicians, and the general public to help arrest and ultimately reverse the CAD epidemic in India. What began as an observation by a young cardiologist in Chicago grew into a decades-long

scientific and educational mission. Treatise on Heart Disease in Indians is the product of that journey and a timely call for earlier recognition, prevention, and treatment of cardiovascular disease among Indians. The enduring lesson is a simple but powerful one: we cannot wait for the first heart attack to begin preventing heart disease.

For Indians and other South Asians, cardiovascular prevention must begin early, continue throughout life, and be guided by a clear understanding of their distinctive risk profile. In that regard, Treatise on Heart Disease in Indians is not merely a book about disease. It is a timely appeal for greater awareness, earlier intervention, and a renewed commitment to preventing premature cardiovascular death.

The enduring message is “Prevention is powerful. We cannot wait for the first heart  attack to occur before taking the first steps to prevent heart disease.”

Dr. M. P. Ravindra Nathan is a retired cardiologist and the Author of 'Stories from My Heart' and 'Second Chance' - A Sister's Act of Love, Past Member of Editorial Board - Medical Economics and Cortlandt Forum and Emeritus Editor, AAPI Journal.  

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