Holistic approach to preventive cardiology: Where tradition meets innovation (Fellow's Voice)

Coming from a family of physicians, my passion for medicine has been deeply rooted from an early age. However, it was my late grandfather, a revered physician, devout sikh, and yogi, who inspired my interest in preventive cardiology. Anecdotally, we share the same birth date, which I see as a connection that strengthens my commitment to his philosophy for preventive and promotive health. He was a pioneer in preventive medicine, who was known for healing his patients through an integrated approach that combined physical, mental and spiritual well-being.

During my clinical rotations in community medicine as a medical student, I spent time in many rural areas of western India where I witnessed stark disparities in access to healthcare. Many patients belonging primarily from marginalized communities had very limited access even to basic medical resources. The mobile medical dispensary units were essentially the only healthcare they received. While I was posted in one such mobile unit, I met Ajibai, a 98-year-old woman, a farmer, who travelled long distances bare-foot just to receive her routine medicines. Although she showed resilience, her frail outlook and loss of hope for the future reflected the suffering she had endured in her life. She shared with me about her two sons, both of whom also had heart disease. She also told me that she prayed daily so that her grandchildren do not go through the same fate. She asked me two questions- could I give her a medicine that would protect her grandchildren from developing heart disease? And why, despite the advancements in medical science were people still suffering and dying from preventable heart diseases? I found myself at a loss for words at that moment, but that encounter completely transformed my understanding of preventive medicine. I came to realize the gap in health literacy and lack of awareness about preventive measures at the grass-root level. As an early career professional, I feel this is the perfect time to start being mindful about prevention. I strongly feel that empowering medical students, residents and fellows-in-training in initiatives focused on preventive cardiology can significantly impact public health. The enthusiasm of the young professionals fueled with the latest medical knowledge and technology can foster innovative strategies to promote a heart-healthy and balanced approach to life. This is especially true for low- to middle- income countries where cardiometabolic diseases are epidemic. Limited access to basic medical resources and healthcare facilities add to this burden. Positive efforts in this direction could eventually decrease the burden of cardio-metabolic diseases in these communities.

Cardiovascular disease (CVD) remains the leading causes of mortality and morbidity worldwide. As a medical student with a keen interest to pursue cardiology, I have encountered numerous patients suffering from CVD, many of whom could have avoided their conditions via earlier risk assessment, lifestyle practices, and/or preventive medications. Cardiometabolic diseases, often silent and chronic in nature, incubate over years before manifesting as life-threatening complications. Despite efforts to address traditional risk factors such as hypertension, hyperlipidemia, obesity, and diabetes, and promote the ‘essential eight’ in combating CVD [1,2], a significant gap remains, highlighting the need for more effective strategies to enhance cardiovascular health. Many protective lifestyle habits such as physical activity, yoga, meditation, dietary habits, optimal sleep, mental health, interpersonal relationships, and role of emotions- compassion, gratitude, mindfulness, and purposefulness are often overlooked, not discussed adequately and/or pushed toward the periphery in modern clinical practice [[3], [4], [5]]. The term ‘lifestyle interventions’ is commonly used by clinicians to encompass all non-pharmacologic preventive strategies, however, not only may this term oversimplify the impact theses interventions can have, but it may also limit the individual attention each intervention requires for conferring risk reduction.

Based on clinician-patient shared decision-making, an additional aspect of preventive care may include spirituality and religion [6,7]. While these practices are sometimes included in palliative care, they are hardly ever included in mainstream medical practice, despite many physicians using these to cope up with the stressors of daily living themselves. A paucity of research in this domain may limit our ability to validate the potential benefits of these methods on patient outcomes [8,9]. However, we should strive to personalize preventive care based on patient characteristics and preferences, including the consideration of mindfulness approaches such as yoga, meditation and spirituality.

A holistic approach to prevention is not limited to a heart-healthy lifestyle, it also extends to positive thinking and balanced behaviors. Traditional medical literature including the Charaka Samhita and Ayurveda have clearly described the benefits of rasayana (promotive treatment) as the only way of attaining a disease- free life [10,11]. The philosophy of preventive medicine is based on four pillars- character (achaara), thoughts (vichaara), eating habits (ahaara), and interpersonal dealings (vyaavahaara). Human emotions of faith, hope and compassion, though impossible to quantify in clinical trials, seem to have a strong impact on patient well-being. Understanding the importance of the roles played by each team member- the physician, the nurse, family members, and the patient themselves can enhance the healing process. While modern medicine has achieved remarkable advances in CVD management, these solutions often come too late for patients already suffering from the disease or its complications. Patients who reach this stage require treatment for their symptoms and to prevent further complications (secondary and tertiary prevention), and not to reverse the course of the illness which could have been done earlier (primordial and primary prevention). Thus, there is an urgent need to prioritize preventive and promotive cardiometabolic health. This also fuels a greater need to revive and invest in research on traditional practices as lifestyle and non- pharmacological preventive strategies. Such efforts will not only validate the effectiveness of these preventive practices but will also complement the achievements of modern medicine. The convergence of tradition with innovation is the call-of-the-hour to transform the future of cardiology and impact millions of lives across the globe. By doing so, I aim to provide Ajibai and countless others with not just hope, but also a clear path ahead to protect future generations from CVD in the years to come.

CRediT authorship contribution statement

Amanpreet Singh Wasir: Conceptualization, Project administration, Writing – original draft, Writing – review & editing.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.