One of world’s leading cardiologists shares recipe for long life and most cost-effective way to reduce heart diseases
Dr Sanjay Rajagopalan, Director of the Case Cardiovascular Research Institute, is winner of 2025 American Heart Association (AHA) Distinguished Scientist Award.
Sanjay Rajagopalan, Chief of Cardiovascular Medicine at University Hospitals Harrington Heart and Vascular Institute and Director of the Case Cardiovascular Research Institute at Case Western Reserve University School of Medicine, in Ohio won the 2025 American Heart Association (AHA) Distinguished Scientist Award. It's the highest honour bestowed by the Association to recognise those who have advanced the understanding of cardiovascular disease (CVD) and stroke.
Dr Rajagopalan’s work has helped transform global perceptions and understanding of the impact of environmental risk factors on CVD. He has also made contributions to the development of next-generation therapies for cardiovascular disease, and is an authority in advancing innovative approaches for the imaging of complex heart diseases.
“It’s deeply humbling to receive this award, not just as a recognition of my work, but as a recognition that the environment and heart health are finally being seen as inseparable,” says Dr Rajagopalan. “The heart does not beat in isolation. It beats in rhythm with the world around us.” Here’s an exclusive interview:
What does this recognition from the American Heart Association mean to you?
It's a great privilege, a very distinguished recognition of the work. To be selected amongst thousands of cardiologists every year is a unique privilege. I'm delighted, but equally delighted for what this means for the area of science that I'm involved in. It recognizes the work linked to science research, but also to translational research- the underpinning of whatever we do in cardiology. It's evidence-based. The recognition is really an acknowledgment of the science that goes into decision making in the area of cardiology and a link between the work that I've done in the environment space. A lot of it is underpinned by the fact that we use research methodology to succumb to conclusions about the world around us, as well as the world within us.
Can you elaborate on the impact of environmental risk factors, specifically air pollution on cardiovascular diseases?
Air pollution is the second leading cause of global mortality right after hypertension which is the leading cause. It doesn't include any other environmental variable. Just the math of this means that if you add together all the known knowns, and we know very little about environmental risk factors, then that's a part of it that really should be a clarion call for waking up, particularly in India, which is in the crosshairs of multiple environmental exposures. Air pollution is singularly the most important problem that we currently face and are going to face in the years to come. More than 60% of deaths attributable to air pollution are those that have led to cardiovascular problems.
When examined in that lens of why this is important for the subcontinent, it is a massive and a very important actionable area of health. Everyone’s entitled to good, clean air, clean water, and clean food. There should be an unmitigated attempt to curb exposure to air pollution, particularly in vulnerable communities, such as children. Early exposure during childhood causes permanent damage to your lung capacity or sets you up for future problems. Since it’s not a problem that individuals can solve alone, it's changes at policy and governmental level that are vital. In light of the fact that this is such a humongous human tragedy, there needs to be a no-tolerance policy, and all hands on deck in terms of solving the problem. Also, air pollution costs India enormously. The economic ramifications in terms of sick days, hospitalisations and deaths are massive on a productivity frontier too.
What’s your involvement at policy level?
I have helped position the US policy as part of the committee called the scientific advisory committee (SAC) and the Environmental Protection Agency, which formulates climate policy. I collaborate with researchers to try to come up with useful experiments or quasi-natural experiments that could inform or guide policy. I would be delighted to be engaged in any capacity with the Indian government, as I care deeply about the environment, particularly in parts of the world where policy actions or changes could have a significant impact on population health. The biggest point of convergence that shouldn't take any convincing for everybody is children's health. I hope that children's health is a rallying cry for people to unite in their opposition to anything detrimental to kids.
What are the most prevalent risk factors of CVD?
The leading cause of mortality and death worldwide is hypertension. Cardiovascular diseases have overtaken cancers as the leading cause of global mortality. One of the reasons for that is a growing epidemic of obesity and Type 2 diabetes. India, unfortunately, is the grand center for diabetes. And this is because of an incredible transition, both in terms of transitioning to nutrient heavy foods, changes in dietary patterns, changes in physical activity, densely populated cities that provide little room for recreation, lack of exercise, lack of education, and a profound shift and appetite, and the way people eat. It's just a massive problem.
The US is no different. We are seeing a tsunami of obesity and diabetes. Smoking rates have gone down, but there's been an uptick in practices like vaping. Hypertension, obesity, diabetes, and elevation in LDL cholesterol, are driving heart disease globally.
What can be done to reduce CVD and live long with a healthy heart?
To stem or reduce cardiovascular disease prevalence, there needs to be paid to address not just the risk factors, but also primordial prevention- referring to an area where you don't allow these risk factors to begin in the first place. For example, to prevent the onset of hypertension or diabetes. And that really begins at the kindergarten level with education. It should be a huge priority from childhood. Also, educating families and how they feed their kids, what they consume in school and physical activity. You build good habits like physical exercises in school. It should be mandatory. People should understand that good food is about intelligent choices. Like a transition from eating a carbohydrate-rich diet to a protein rich diet. That should be the real focus because in the long run, that's the most cost effective way.
The American Heart Association has a big push on primordial prevention. If you sleep well, do good physical activity, don't smoke, control hypertension, eat a good diet and are not obese- that should give you a fairly good lifespan and healthspan. It’s a good recipe for longevity in general.
Any next generation therapies for CVD and any innovative approaches for imaging.
We are at a very interesting crossroads in medicine- at a confluence of artificial intelligence and genetic technologies, which are really going to redefine the era of medicine. Diseases that would have, essentially, relegated you to premature death, with no options are now becoming curable. There are some cardiac conditions, like amyloidosis that can now be completely solved. But these are expensive treatments.
From a larger population perspective, the previous century practices work best like eating less, walking more, and eating more plant based foods. I would say, these are the three fundamental requisites for good cardiovascular health. Prevent yourself from getting to be a diabetic, obese, and hypertensive. These are all connected risk factors that can be solved by healthy dietary practices and exercise.
What can be done to offset the genetic predisposition that South Asians face?
Genetically speaking we are all the same. The genome is 99.5% or more similar. What's different is the genetic environment interactions-meaning the epigenomic responses or the responses to environmental triggers. For instance, if a South Asian is exposed to a high fat diet, they respond very differently than somebody in Europe or China. This is the epigenomic framework, where genes are expressed differently based on the environment you are placed in.
Anything that you might like to add on the young people, getting more cardiovascular diseases than was earlier seen.
It’s very tragic and not based on traditional risk factors. And this is where I think there should be a lot of attention on setting up a large registry of such patients where we are able to collect tissue samples, bio-bank specimens, and a very detailed history on patients. I believe that environmental exposures of these patients might be very important. What might be singularly different about these patients might be an increase in environmental exposures. There are many parts of India, as well as in North America, that have high exposure to lead, cadmium, arsenic, and other toxic metals, as well as chemicals and large amounts of plastic, which are ubiquitous and all around you. This is compounded by profound, high levels of air pollution. In conjunction with other risk factors, this can be very dangerous. It's a huge problem, very unbelievably disturbing. When you're at the peak of your livelihood, it’s medically and economically catastrophic.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
