Matters of the Heart: Dr. Jagat Narula on Prevention, Genetics, and the Power of Choice
By Somdatta Basu
Houston (TX): A recent Open Forum IACCGH Business Hour turned a Saturday drive-time slot into a masterclass on why hearts fail — and how much power individuals still have to change their fate. The guest, world-renowned cardiologist Dr. Jagat Narula of UTHealth Houston and President of the World Heart Federation, moved easily between stories of ancient mummies and very modern Houston commutes to make one point plain:
“Most of this disease is preventable if we respect our biology.”
A Journey into Cardiology
Born in Ajmer, trained in Jaipur and at the All India Institute of Medical Sciences in New Delhi, Dr. Narula went on to fellowships at Massachusetts General Hospital and Harvard Medical School before leading cardiology programs from Philadelphia to California and New York.
He smiles when he recalls how a grandfather’s one sentence — “I thought my grandson was going to be a cardiologist,” — pulled him away from nuclear physics.
If he had to choose again, he told listeners:
“I would not be anything other than a cardiologist.”
Why South Asians Face Higher Heart Risks
Much of the conversation focused on why South Asians develop heart disease earlier and more severely than many other groups.
Dr. Narula described a pattern he calls being “simultaneously lean and metabolically obese” — slim by European standards, yet carrying dangerous fat wrapped around the liver, pancreas, and heart.
That visceral fat drives inflammation, insulin resistance, and the early arrival of diabetes, hypertension, and coronary artery disease, particularly in Indians living abroad with sedentary jobs and 24-hour access to food.
“The genes that once helped us survive famine are now trying to kill us in times of abundance,” he warned.
Ancient Genetics, Modern Lifestyle
To explain that genetic legacy, he took listeners back 250,000 years to the so-called mitochondrial Eve in southern Africa, then traced how human migrations through the Middle East into South Asia selected for bodies that could store every spare calorie around the belly “for a rainy day.”
Those same mitochondrial settings, he argued, now collide with lifestyles built on elevators, desks, and constant snacking.
Lessons from Mummies and Ancient Civilizations
One of the show’s most memorable sequences drew on his work scanning mummies. Egyptian nobility, naturally mummified Andean farmers, and even Ötzi the Iceman all showed clear signs of atherosclerosis.
The elites of ancient Egypt had feasts, beer, and cakes; the Andean villagers had clean diets but breathed smoke from cooking fires in low, smoky huts.
Pollution, rich food, and inactivity, he concluded, have been injuring arteries for millennia.
“Atherosclerosis is not new,” he said. “What is new is that we understand it well enough to fight back.”
The Sugar Connection Begins Early
Fighting back, in his view, starts astonishingly early.
At birth, humans — like other mammals — carry LDL cholesterol around 25–30 mg/dL, far lower than the levels most modern children reach by age three.
Dr. Narula’s research points a finger at sugar-laden infant formulas and early diets. After World War II, he noted, sugar rationing ended in Britain and national sugar intake doubled overnight.
Children born in the years following rationing later showed higher rates of diabetes, hypertension, and heart disease than those born just before.
“We are addicting them to sugar at a very young age,” he said, urging parents to be far more cautious about sweetened formula and processed foods.
Modern Treatments and Prevention
On treatment, he was unequivocal. Statins, he said, are:
“One of the best things that has happened to mankind.”
Particularly for South Asians whose lipoprotein(a) and LDL levels place them at exceptional risk.
He praised the Lipid Association of India for boldly recommending an LDL goal of 30 mg/dL in coronary patients:
“We are born with 30; why not take that same level to the grave?”
Newer drugs like PCSK9 inhibitors, he added, may help high-risk families “defeat their genetics” altogether.
Simple Habits That Protect the Heart
Yet medications are only part of the prescription.
Drawing inspiration from an Indigenous community along Bolivia’s Manuqui River — where people walk 15,000 to 20,000 steps a day, eat once daily, and rarely smoke — he distilled the formula for healthy arteries into a few rules:
- Eat less, less often
- Move much more
- Protect the liver from constant sugar and alcohol
- Know your numbers early, especially if heart disease runs in the family
On the door of his clinic, he likes to post a promise:
“Come to me ten years before your father’s heart attack, and I will do everything not to let you have one.”
A Message of Hope and Responsibility
The hour closed where it began: with gratitude and urgency.
The hosts of IACCGH Business Hour thanked Dr. Narula for translating a lifetime of science into simple, actionable truths.
For listeners, the takeaway was as hopeful as it was sobering. Genetics and history set the stage, the cardiologist reminded them, but everyday choices still write most of the story of the heart.