Sanjay Rajagopalan, Chief 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 is the highest honor given by the association to honor those who have advanced the understanding of cardiovascular disease (CVD) and stroke.
Dr. Rajagopalan’s work has helped change global perceptions and understanding of environmental impact Risk Factors on CVD, He has also contributed to the development of next generation treatments for cardiovascular disease, and is an expert in pioneering innovative approaches to imaging complex cardiovascular diseases.
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,“It is extremely humbling to receive this award, not only as recognition of my work, but as 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 huge privilege, a very special recognition of the work. To be selected among thousands of cardiologists each year is a unique privilege. I am happy, but equally happy for what it means for the field of science with which I am associated. It recognizes the work that goes into science research, but also translational research – the foundation of what we do in cardiology. It is evidence-based. This recognition is really an acknowledgment of the science that helps make decisions in the field of cardiology and a link between the work I do in the field of the environment. Much of this is based on the fact that we use research methodology to draw conclusions about the world around us as well as the world within ourselves.
Can you elaborate on the impact of environmental risk factors, especially air pollution, on cardiovascular disease?
Air pollution is the second leading cause of global mortality after high blood pressure. There are no other environmental variables involved. Just the mathematics of it is that if you add together all of what is known, and we know very little about environmental risk factors, this is one part of it that should really be a clarion call to wake up, especially in India, which is in the crosshairs of many environmental risks. Air pollution is the single most important problem that we are currently facing and will face in the years to come. More than 60% of deaths due to air pollution are due to cardiovascular problems.
When examined as to why this is important for the subcontinent, it is a vast and very important working area of health. Everyone deserves good, clean air, clean water and clean food. Continued efforts should be made to prevent exposure to air pollution, especially in vulnerable communities such as children. Early exposure during childhood can cause permanent damage to your lung capacity or cause problems in the future. Since this is not a problem that individuals can solve alone, changes at the policy and government levels are important. Considering the fact that this is such a huge human tragedy, there needs to be a policy of zero tolerance and every possible effort needs to be made to solve the problem. Moreover, air pollution causes huge losses to India. The economic impacts are also massive on the productivity front in terms of sick days, hospitalizations and deaths.
What is your involvement at the policy level?
I have helped set US policy as part of a committee called the Scientific Advisory Committee (SAC) and the Environmental Protection Agency, which formulate climate policy. I collaborate with researchers to try to come up with useful experiments or quasi-natural experiments that can inform or guide policy. I would be delighted to be associated with the Government of India in any capacity, as I care deeply about the environment, especially in parts of the world where policy actions or changes could have a significant impact on population health. The biggest point of convergence that should not be reassuring to everyone is children’s health. I hope Children’s Health is a rallying cry for people to unite against anything that is harmful to children.
What are the most prevalent risk factors for CVD?
High blood pressure is the leading cause of death and mortality worldwide. Cardiovascular diseases have overtaken cancer as the leading cause of global mortality. One reason for this is the growing epidemic of obesity and type 2 diabetes. India, unfortunately, is a hotbed of diabetes. And this is because of an incredible transition, a transition toward nutrient-rich foods, changes in dietary patterns, changes in physical activity, densely populated cities that offer little space for recreation, lack of exercise, lack of education, and a profound change in appetite, and the way people eat. This is a very big problem.
America is no different. We are seeing a tsunami of obesity and diabetes. Smoking rates have declined, but practices such as vaping have increased. High blood pressure, obesity, diabetes and increased LDL cholesterol are increasing heart disease globally.
What can be done to reduce CVD and live longer with a healthy heart?
To prevent or reduce the prevalence of heart disease, there is a need to pay attention not only to addressing risk factors, but also fundamental prevention – referring to an area where you do not allow these risk factors to occur in the first place. For example, to prevent the onset of high blood pressure or diabetes. And it really starts with education at the kindergarten level. This should be a big priority right from childhood. Also, educating families and how they feed their children, what they eat at school and physical activity. You form good habits like physical exercise in school. This should be mandatory. People must understand that good food depends on wise choices. Like transitioning from a carbohydrate-rich diet to a protein-rich diet. This should be the real focus because in the long run, this is the most cost-effective approach.
The American Heart Association has a big emphasis on fundamental prevention. If you sleep well, get good physical activity, don’t smoke, control high blood pressure, eat a good diet and aren’t obese – this will give you a pretty good lifespan and health. In general this is a good recipe for longevity.
No next-generation therapies for CVD and no novel approaches to imaging.
We are at a very interesting crossroads in medicine – at the confluence of artificial intelligence and genetic technologies, which is really going to redefine the era of medicine. Diseases that would inevitably lead to premature death without any alternative are now becoming curable. There are some cardiovascular conditions, such as amyloidosis, which can now be completely resolved. But these are expensive treatments.
From the perspective of the larger population, the practices of the last century work best such as eating less, moving more, and eating more plant-based foods. I would say, these are the three basic requirements for good heart health. Save yourself from suffering from diabetes, obesity and high blood pressure. These are all associated risk factors that can be addressed by healthy dietary practices and exercise.
What can be done to overcome the genetic predisposition that South Asians face?
Genetically speaking, we are all the same. The genome is 99.5% or more identical. What is different is genetic-environment interactions—that is, epigenomic responses or responses to environmental triggers. For example, if a South Asian person is exposed to a high-fat diet, they react very differently than someone from Europe or China. This is the epigenomic framework, where genes are expressed differently depending on the environment you’re exposed to.
Young people are getting more heart disease than ever before, so you might want to add.
This is very sad and is not based on traditional risk factors. And this is where I think a lot of attention should be paid to setting up a large registry of such patients where we are able to collect tissue samples, bio-bank samples and a very detailed history on the patients. I believe that the environmental exposure of these patients may be very significant. What may be different about these patients may be increased environmental exposures. India, as well as many parts of North America, are at higher risk of exposure to lead, cadmium, arsenic and other toxic metals, as well as chemicals and large amounts of plastic, which are omnipresent and all around you. It is linked to intense, high levels of air pollution. In combination with other risk factors, this can be very dangerous. This is a huge problem, so incredibly troubling. When you are at the peak of your livelihood, it is devastating medically and financially.
Note to readers: This article is for informational purposes only and is not a substitute for professional medical advice. Always seek the advice of your doctor with any questions you may have about a medical condition.
