The vast majority of cardiovascular research emphasizes the high burden of heart diseases and the preponderance of these diseases in mortality.^, Efforts to learn how major cardiovascular diseases are managed have been led by the countries with the greatest economic power. However, a large part of the world’s population has been forgotten, because the realities of life in developing countries make it impossible to apply all the recommendations. As a result, adverse cardiovascular outcomes remain common, reducing quality of life and life expectancy. In the following paragraphs, I will comment on chronic coronary syndromes, specifically on the efforts made by physicians in India to adapt the management of this disease to their resources and situation.

The underlying pathophysiology of chronic coronary syndromes is myocardial ischemia caused by alterations in coronary flow, mostly due to atherosclerosis, and they are part of a continuum in which atheromatous plaques can become complicated and unstable, causing acute coronary syndromes. To speak of chronic coronary syndromes is not only to refer to a phenomenon at the coronary level but also to consider the associated risk factors. The most common risk factors are hypertension, diabetes, dyslipidemia, smoking, and physical inactivity. However, other non-conventional factors such as exposure to pollutants, social deprivation, occupational stress, hormonal changes, environmental noise, and the area of the world in which we live must also be emphasized. All these phenomena can cause alterations in coronary flow, either by atheroma plaque or by alteration of the microcirculation. For the diagnosis of these diseases, many studies are required, such as electrocardiograms, echocardiograms, cardiac scintigraphy, magnetic resonance imaging, coronary artery tomography, or invasive coronary angiography. Initial treatment is medical, but in many cases, a revascularization strategy will be necessary, either by surgery or percutaneous coronary intervention.

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