Sanjay Rajagopalan MD: exploring the interconnected worlds of cardiovascular health, environment, and sustainability (2025)

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Distinguished physician-scientist Dr Sanjay Rajagopalan's career has been marked by a profound commitment to investigating the connections between health and the environment. His groundbreaking work has shed light on the impact of air pollution on cardiovascular diseases and now extends to broader concepts of sustainability and the interplay between genes and the environment (Figure 1).

He is the recipient of an 8-year, $7.5 million Revolutionizing Innovative, Visionary Environmental health Research (RIVER) award from the US National Institutes of Environmental Health Sciences—part of the National Institutes of Health (NIH). Dr Rajagopalan serves as a professor at the School of Medicine, at Case Western Reserve University (CWRU) in Cleveland, Ohio, but was born and raised in India, where he obtained his medical diploma.

Following extensive training in the US including a cardiology fellowship, Dr Rajagopalan had always expected to follow a ‘conventional’ career investigating aspects of cardiovascular disease such as hypertension and high cholesterol. By the early 2000’s, he had established a laboratory at the University of Michigan looking at cutting edge topics such as gene therapy. However, the realization that the traditional style of focusing on individual risk factors was too narrow a perspective to understand the complex context of cardiovascular disease, caused him to rethink his approach.

A chance collaboration and a series of experiments with a colleague at the University of Michigan who was researching air pollution in the early 2000s, prompted this change of tack. Using a car diesel engine to simulate every day city pollution in a confined space revealed that vehicle emissions had acute effects on vascular function. He says: ‘This resulted in a deep realization that we need to step back and take a zoom-out view of health and the multitude of influences such as chemicals, plastics, and the built environment that impact cardiovascular health. It's not just an intellectual understanding of the problem that we need, but an understanding of what to do about it.’ This was a fundamental shift in understanding the impact that the environment at large has on individuals, and it consequently expanded the lens through which he viewed health beyond individual risk factors to encompass the interconnected nature of risks that define modern existence.

In the years following the Millenium, Dr Rajagopalan conducted extensive studies, utilizing both animal models and human subjects to explore the effects of a range of environmental factors on cardiovascular diseases. He became an advocate for integrating sustainability principles into clinical approaches to patients and into the wider healthcare industry. His recent completion of a Master of Business Administration (MBA) at the Sloan School of Management of Massachusetts Institute of Technology, reflects this dedication to ‘zooming out’ and underscores a commitment to understanding how sustainable practices can transform healthcare delivery and contribute to both individual and planetary well-being. The culmination of his experimental work and joined-up approach to bridging medicine, environmental sciences, and sustainability has positioned him as a thought leader advocating for sustainability in healthcare.

He says: ‘The focus of the MBA was looking at how we think about sustainability and health care. Healthcare is a massive consumer of goods, capital, and the source of much anthropogenic activity that produces anywhere from seven percent to 10 percent of global CO₂. We don’t reuse or recycle and that affects the environment. My hope is that sustainability can be a panacea for this problem and that reimagining and rethinking the world in sustainable ways is the future. This approach would not only transform healthcare delivery but also result in a new definition of health where fundamentally what's good for cardiovascular health is also good for planetary health.’ This vision extends to individual patient care and the creation of a ‘virtuous circle’ which supports a broader commitment to planetary health, emphasizing the interconnectedness of cardiovascular well-being and sustainable living.

The interconnected nature of global phenomena such as the global COVID-19 pandemic, he says, underscores how events far away can impact human health in other parts of the globe. This implies the immediate need for a broader perspective on how the environment affects human health. Physicians should collaborate with engineers, architects, and environmental experts and promote sustainability in both their workplace and in their working lives. Health, Dr Rajagopalan suggests, is the main arena in which everyone—patient and health care giver—can see the impact of an unhealthy environment and effect change on a personal and global level by adopting more sustainable lifestyles and work practices. He says: ‘Health is where climate change hits home to most individuals who start to look at the world in a different way when they make the connection between planetary disruption and health problems.

He is adamant that the health industry, like every other sector of the economy, can, and must, adopt a strong commitment to sustainability. ‘Every Fortune 500 company is focused on being sustainable and running their business in a way that makes money. It's high time for us as health care providers to start thinking about ways in which we can bring sustainable care to our patients and how we can reimagine healthcare in a way that sets the example for society at large.’

The RIVERS award from the NIH aims to unravel how genetic predispositions interact with environmental factors to influence chronic diseases. He says: ‘Our goal is to understand how the environment modulates or affects genetic predisposition. In other words, if you have genetic protective factors, can you mitigate the effects of the environment and conversely, if you’re high risk genetically speaking for cardiovascular disease, are you then more prone to the effects of environmental factors? It’s a big question which is the topic of intense research efforts of many groups, not just mine.’ A specific focus of the project will be on how environmental aspects such as noise and air pollution can disrupt circadian rhythm.

Dr. Rajagopalan characterizes the career of the physician—scientist as ‘a restless quest’, driven by curiosity and inspired by discovery leading the individual to collaborations with like-minded peers to explore diverse fields, and to discover and adopt new technologies. He advocates for a trans-disciplinary approach to scientific investigation, emphasizing the importance of equipping medical professionals with the tools for complex problem-solving, including machine learning and bioinformatics. Aside from the acquisition of knowledge however, he believes the old-style soft skills are vital, and there is a need for empathy and compassion to reconnect with patients on a one-to-one basis. ‘The reason why we exist is our patients, so there also needs to be a new narrative in which one-on-one communication needs to be reinvented and re-evaluated following the disruption of COVID-19.’

Declarations

Disclosure of Interest

All authors declare no disclosure of interest for this contribution.

© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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