In this “Heart India” issue, we are publishing three editorials, one review article, 12 original research articles, one case report, and one letter to editor. Earlyonset myocardial infarction (MI), defined as MI occurring in individuals under 45 years of age, is an emerging global health concern with unique epidemiological, clinical, and management challenges. In the first review article, Patel et al.1 have discussed the risk factors of early-onset myocardial infarction and the diagnostic challenges in the diagnosis of myocardial infarction in younger adults in a comprehensive manner. Mineralocorticoid receptor antagonists (MRAs) are a key component of guideline-directed therapy for heart failure (HF). In the first original research article, Garg et al.2 have studied the current practice and perceptions on the use of MRAs in the management among Indian physicians. Although MRAs are widely acknowledged as effective in HF treatment, underuse and suboptimal dosing remain challenges in India, largely due to limited awareness. Coarctation of the aorta (CoA) is a congenital narrowing of the aorta that is typically located at the junction of the aortic arch and the descending aorta, distal to the origin of the left subclavian artery. In the second original article, Mohsin et al.3 have reported the immediate and intermediateterm outcomes of stenting for native and residual CoA. Stenting for CoA is safe and effective, providing sustained gradient relief and coarctation segment expansion. Persistent hypertension (HTN) after stenting remains a significant concern, with ABPM revealing a higher prevalence of HTN than detected by office measurements. Long-term follow-up is crucial to monitor BP control and detect potential complications. Cardiac resynchronization therapy (CRT) has emerged as an important treatment modality for patients with heart failure and conduction abnormalities. The anatomical variations of the coronary sinus (CS) significantly impact the success of left ventricular lead placement during CRT implantation. In the third original research article, Saba et al.4 have studied the CS anatomy variation with respect to left ventricle lead implantation in the CRT in the Kashmiri population. Understanding CS anatomical variations is crucial for successful CRT implantation. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, and dyslipidemia is one of the major risk factors for CVD. In the fourth original research article, Nagarajan et al.5 have studied high-intensity lipid-lowering therapy with rosuvastatin and ezetimibe for uncontrolled dyslipidemia in Indian patients. Rosuvastatin and ezetimibe therapy was an effective and well-tolerated lipid-lowering agent, offering higher efficacy, especially in the reduction of low-density lipoprotein cholesterol (LDL-C) levels. Antiplatelet therapy plays a key role in the postpercutaneous coronary intervention (PCI) period. Current recommendations suggest dual antiplatelet therapy (DAPT) for at least 12 months for patients with acute coronary syndrome (ACS) undergoing PCI. In the fifth original research article, Chirde et al.6 have studied the clinical outcomes of switching from prasugrel to the more economical clopidogrel after 3 months. The authors of this study concluded that, in patients with ACS who underwent PCI, switching from prasugrel to clopidogrel after 3 months did not significantly affect clinical outcomes. This strategy offers an economical DAPT option for patients with lower socioeconomic backgrounds. Breast arterial calcification (BAC) visible on routine screening mammography is emerging as a potential marker for CVD risk in women. In the sixth original research article, Attili et al.7 have studied the pooled data from three institutional cohorts in India to evaluate the association between BAC, angiographically confirmed coronary artery disease (CAD), and survival outcomes. Authors of this study concluded that BAC independently predicts obstructive CAD and poorer survival among Indian women, beyond traditional risk factors. Routine BAC reporting in mammography and integrated cardio-oncology referrals may enhance cost-effective CVD risk stratification in India. Premature CAD, defined as onset at or before 45 years of age, has a disproportionately higher prevalence among South Asians compared to Western populations, with Indian individuals particularly affected. Traditional lipid metrics primarily quantify LDL-C but often fail to reflect qualitative changes, such as LDL oxidation, which may contribute to residual cardiovascular risk. In the seventh original research article, Kathariya et al.8 have studied the discordance between equation-based LDL-C estimations and oxidized low-density lipoprotein as a determinant of residual cardiovascular risk in CAD. Authors of this study concluded that, although LDL-C equations provide reliable estimates of LDL cholesterol levels, they do not capture oxidative modifications that contribute to residual cardiovascular risk. Integrating ox-LDL assessment into routine screening may strengthen early detection and enable targeted prevention, addressing the escalating public health burden of premature CAD among young Indians. HTN is the primary modifiable risk factor for chronic coronary syndrome (CCS), which significantly contributes to morbidity and mortality. In the eighth original research article, Garg et al.9 have gathered expert consensus from Indian cardiologists on managing HTN in patients with CCS, to optimize therapy and improve patient care. This consensus highlights the clinical strategies for managing patients with CCS and associated comorbid conditions. The key diagnostic tools, such as ambulatory blood pressure monitoring and Holter electrocardiogram, are strongly recommended for comprehensive evaluation. Pharmacological management should prioritize the use of angiotensin II receptor blockers and beta-blockers combinations, particularly telmisartan–metoprolol fixed-dose combination (FDC) in the management of hypertensive CCS patients with type 2 diabetes mellitus or dyslipidemia. Inotropes are the medications that enhance cardiac contractility or induce vasoconstriction in patients with cardiogenic shock (CS), a life-threatening complication of ACS associated with significant morbidity and mortality. In the ninth original research article, Charaniya et al.10 have studied the equations for predicting changes in hemodynamic parameters by various inotropes in patients with CS with ACS. The authors of this study concluded that formulae to predict the expected change in hemodynamic parameters while using inotropes can be used to achieve the desired hemodynamic changes instead of the arbitrary usage of the currently used hemodynamic parameters. CVDs are the leading cause of global mortality, with obesity and oxidative stress contributing significantly to their pathogenesis. In the tenth original research article, Shivakumar et al.11 have studied the role of obesity and oxidative stress as an important link in CVD genesis in the young. Authors of this study concluded that oxidative stress biomarkers, particularly malondialdehyde (MDA), may be more closely linked to cardiovascular risk than body mass index alone. The inverse relationship between superoxide dismutase and CVD risk suggests its protective role. These findings highlight the need for integrating oxidative stress markers with conventional risk factors for improved CVD risk assessment. In the eleventh original research article, Shetty et al.12 have studied the role of the interatrial septal (IAS) thickness as a marker of atherosclerosis and its correlation with the presence and severity of CAD. The authors of this study concluded that IAS thickness is a powerful, noninvasive, and independent marker for the presence and severity of CAD. An IAS thickness >6 mm is a highly sensitive and specific indicator of underlying atherosclerosis. The routine measurement of IAS thickness through echocardiography can serve as a simple and valuable tool for cardiovascular risk stratification. Coronary endarterectomy (CE) is a demanding but valuable adjunct to coronary artery bypass grafting (CABG) for diffuse, calcific CAD, particularly in resource-limited settings where complete revascularization may otherwise be impossible. In the twelfth original research article, Lakhote et al.13 reported their single-center experience of coronary endarterectomy with CABG in diffuse CAD. Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly affecting approximately 0.002% of the population. In this issue, Bhandari et al.14 reported a rare case of ARCAPA in a 30-year-old young male adult presented with a 3-month history of exertional chest pain and dyspnea. In the last, in letter to editor, Nazir et al.15 reported a highimpact of checklist-guided management for ACS. Authors of this letter reported that, by integrating this checklist into routine follow-up, hospitals can improve patient outcomes and take a step toward safer, more effective, and accountable cardiac care in India.
Alok Kumar Singh (Thu,) studied this question.