Editor’s Page

Coronary artery disease (CAD), a major global disease, accounts for a significant number of hospital admissions in India. All of us are aware that this entity occurs a decade earlier in India and is quite different from the disease worldwide. This issue of the journal looks into the utility of diagnostic modalities in the Indian scenario, with a focus on the younger patients with ischemic heart disease Premature CAD is highly prevalent in India; diffuse and multivessel disease has been known to occur frequently. The study by Jain et al. is noteworthy because it included a large number of patients under 35 years of age in this cohort.1 Interestingly, conventional risk factors were observed in a third of the patients in the very young, leading to early CAD. This really calls for preventive strategies in early life. Interestingly, unlike the data from Western countries,2 high triglyceride and low high-density lipoprotein (HDL) are clearly evident in this study. Thus, non-HDL cholesterol, a target for coronary prevention, may be a target for preventive strategies in India. At the same time, it is important to diagnose CAD using multiple imaging modalities. The study by Mohapatra et al., on the use of a simple transesophageal echocardiogram to identify high-risk patients, is commendable.3 However, this could only be a research tool as coronary imaging remains the gold standard. These are add-on tools to the conventional electrocardiogram for diagnosis. The use of artificial intelligence in this regard would be complementary.4 In the context of early CAD detection, a less expensive diagnostic test merits consideration. This is clearly demonstrated by Abhishek Kumar et al., who focused on diagnostic accuracy and lesion progression in calcium scoring.5 This is a well-established tool in risk stratification when added to the conventional risk scores. The utility of this in the Indian context is very well brought about by this large dataset. This has abundant scope in preventive health checkups in the country. Coronary Computed Tomography angiography as a ‘one-stop shop’ is attractive for future chest pain assessment.6 This issue has a consensus publication based on available literature on the use of angiotensin receptor-neprilysin inhibitor in hypertensive patients.7 These are all attractive options in patient management. A lot of data on aldosterone blockade in hypertension have been published and are noteworthy.8 These newer drugs would soon be available in the Indian market.