Although the incidence of coronary artery disease (CAD) is decreasing in many western countries, especially Finland and the United States, the burden of CAD is rapidly increasing in India. CAD also occurs at relatively young age in Indians and can be severe in nature. There is ongoing research to identify the risk factors for this malignant disease.

The present issue of the journal includes three articles that assess the relationship between the severity of CAD and risk factors. In the first study, the relationship between the risk factors and severity of CAD is studied using coronary angiography in 302 patients. As expected, patients with multiple risk factors were found to have a much severe disease, suggesting the need for preventing the disease at early stages. The second article assesses the correlation between epicardial fat volume and severity of CAD and calcium score. In this interesting study, authors found a good correlation between epicardial fat volume and the severity of CAD and coronary calcium score. Larger studies are needed because epicardial fat is as metabolically active as abdominal visceral fat found in metabolic syndrome.

Another article describes CAD patterns using Gensini score in the rural and city populations in 400 patients undergoing coronary angiography. It is well known that CAD is more common in the urban population than the rural population in India, although the gap is recently narrowing. In this study, the authors observed a higher Gensini score in city populations, indicating increased burden of coronary artery lesions. Gensini score was also reported to be higher in the city population among individuals who are smokers, have hypertension, lead a sedentary lifestyle, are obese and have family history of CAD.

The next article is a review on the current role of carbohydrates for the causation of cardiovascular disease. This article quotes several studies that suggest that high carbohydrates, particularly refined carbohydrates, have a correlation with the occurrence of cardiovascular disease and, hence, suggests that carbohydrates should be restricted to 50%–55 % of total daily calorie intake. The last article is a review on peripartum cardiomyopathy, which is a disease with significant mortality and unknown cause.

This issue also presents a short profile of Professor Paul Ridker of Harvard Medical School. Dr. Ridker is well-known for the inflammatory hypothesis of coronary artery disease and has participated in several landmark trials, such as the JUPITER and CANTOS.

I hope this issue will be useful for the practicing clinicians, and comments are welcome.

Dr. S. C. Manchanda Editor-in-Chief Senior Consultant Cardiologist Sir Ganga Ram Hospital, New Delhi, India