Professor Maciej Banach, distinguished colleagues, dear friends from Poland, and Central and Eastern Europe:
Dzień dobry, Warsaw!
I had very much hoped to be with you in person. My dear friend Maciej was persuasive, as he always is, and for a while I thought I might have discovered the secret of being in Warsaw and Rio almost simultaneously. Unfortunately, even the World Heart Federation has not yet mastered quantum cardiology. So, my colleague and the President-Elect, Professor Prabhakaran, will be there with you physically, while I have the privilege of joining you virtually.
But if ever there were a city in which one could participate from afar and still speak about the heart, it is Warsaw. Because not far from where you are meeting today rests perhaps the most famous heart in Poland. The heart of Fryderyk Chopin.
Chopin died in Paris in 1849, but he asked that his heart be returned to Poland. His sister brought it home, and today it rests in the Holy Cross Church here in Warsaw. It is a remarkable story. His body remained in Paris. His heart came home. Perhaps cardiologists are among the few people who visit Warsaw and immediately ask—I did so when I was there last about 12 years ago: “Where exactly is the 177-year-old heart?” It even became more compelling for me because I had not thought of knowing the cause until my Polish colleagues discussed the terminal event with me. Constrictive Pericarditis and myocardial fibrosis—and that became suddenly so engaging for me. Why? In 1989, as I was completing my cardiology training and moving to the United States, I had submitted a paper to the International Journal of Cardiology (1990 Aug;28(2):245-51. doi: 10.1016/0167-5273(90)90067-f.) At that time, I wrote that clinically similar restrictive heart disease is caused by constrictive pericarditis and endomyocardial fibrosis. We compared autopsy data in heart specimens from 8 patients of constrictive pericarditis of tuberculous origin and 6 patients with tropical endomyocardial fibrosis, and also performed post-mortem endomyocardial biopsies from both ventricles. Pericardial thickening and adhesions were present in all cases of constrictive pericarditis and in none of those with endomyocardial fibrosis. Interestingly, significant endocardial thickening was seen in four, and myonecrosis, lymphohistiocytic cellular infiltration and myofibrosis were observed in seven of the eight cases of constrictive pericarditis. This suggests that the tubercular insult to the heart may involve all three layers with varying severity.
But the story raises another question. We have preserved the heart of one extraordinary composer for nearly two centuries. Can we show the same determination in protecting the millions of living hearts around us today?
That, to me, is the real reason we are gathered.
THE TWO CARDIOVASCULAR EUROPES
We often speak of “European cardiovascular health” as though Europe were epidemiologically homogeneous. It is not. There are still, in effect, two cardiovascular Europes.
One Europe has experienced extraordinary declines in premature cardiovascular mortality, broad access to preventive therapies, sophisticated imaging, revascularization, lipid-lowering drugs, cardiac rehabilitation and organized systems of care. Another Europe, much of it represented by Central and Eastern Europe, continues to experience substantially greater premature cardiovascular mortality, higher exposure to untreated risk factors, and uneven access to prevention. The most recent ESC cardiovascular statistics make the disparity uncomfortable to ignore: across ESC member countries, middle-income nations continue to experience about twice the cardiovascular mortality incidence of high-income countries. This is not a failure of science. We possess the science. It is a failure of translation, implementation and equity. And that is why organizations such as ILEP and WHF must increasingly work together.
THE DOUBLE BURDEN
Central and Eastern Europe faces what we could call a double cardiovascular burden. On one side are diseases that remain neglected, underdiagnosed, undertreated, or unequally treated. On the other hand, there is an accelerating epidemic of preventable vascular and metabolic disease: Hypertension. Dyslipidemia. Diabetes. Obesity. Atherosclerosis. Coronary disease. Stroke.
The older problems have not disappeared. The newer ones have already arrived. And unfortunately, diseases have never been very polite about taking turns. They arrive together. And, that is the challenge.
2026: THE YEAR OF THE HEARTS WE HAVE NEGLECTED
At the World Heart Summit this year, we declared 2026 the Year of Neglected Cardiac Diseases. Rheumatic heart disease. Congenital heart disease. Chagas disease. Inherited cardiomyopathies and aortopathies. These conditions affect tens of millions of people and continue to produce preventable disability and premature death despite remarkable advances in cardiovascular medicine. But I want to focus on one word: neglected. Diseases do not neglect patients. People do. Health systems do. Research agendas do. Markets do. Sometimes specialties do. So, neglect is not an inevitable biological phenomenon. Neglect is a decision. And decisions can be changed.
This year’s World Heart Report focused on congenital heart disease because inequity can literally begin at birth. A child born with the same cardiac defect can have a completely different future depending on the country, city, health system or family into which that child is born. That is not genetics. That is geography. And geography should never become destiny.
FROM WARSAW TO PERTH
In November, the World Heart Federation and the National Heart Foundation of Australia will bring the global rheumatic heart disease community together in Perth. Rheumatic heart disease remains devastatingly common in vulnerable populations despite having been virtually eliminated from many wealthier settings. The World Heart Federation estimates that it affects approximately 55 million people worldwide and causes more than 360,000 deaths each year. Think of the absurdity. A sore throat in childhood. A preventable infection. Years later, a damaged mitral valve. Heart failure. Stroke. A young woman entering pregnancy with a heart already compromised. That is not merely a disease pathway. That is the biography of health-system failure.
We hope Perth will produce not simply another meeting, but what we increasingly call a Perth Declaration, a commitment to move from recognition to implementation. Because declarations alone do not treat rheumatic fever. Penicillin does—a vaccine will. Resolutions do not repair a valve. A functioning health system can. And success will not be measured by how eloquently we describe rheumatic heart disease. It will be measured by the number of children who acquire it.
BUT NEGLECT HAS ANOTHER FACE
Let me now come directly to the community gathered here. Sometimes the neglected problem is not a rare disease. Sometimes it is a common risk factor that everybody knows about, but nobody treats adequately. And perhaps there is no better example than cholesterol. We have understood the causal role of LDL cholesterol in atherosclerotic disease for decades. We have statins. Ezetimibe. PCSK9 inhibition. Inclisiran. Bempedoic acid. We increasingly understand lifetime exposure. We recognize familial hypercholesterolemia. And yet enormous numbers of people at high and very high cardiovascular risk remain undiagnosed, undertreated, or far above recommended lipid targets. So, there is an important lesson here: A disease need not be scientifically mysterious to be neglected. Often, neglect means we know exactly what to do, but we simply fail to do it. That is why lipidology is not a narrow specialty. It is population health.
ATHEROSCLEROSIS DOES NOT BEGIN WITH THE HEART ATTACK
One of the most dangerous misconceptions in cardiovascular medicine is that coronary disease begins when symptoms begin. It does not. The heart attack is often the final punctuation mark in a story that has been written silently for decades. Atherosclerosis begins earlier. Exposure accumulates. LDL particles enter the arterial wall. Inflammation follows. Plaque develops. Some plaques become dangerous. And then, one morning, what appeared to be a healthy person suddenly becomes a cardiac patient. The biology was present long before the diagnosis. That is why prevention cannot begin in the catheterization laboratory. By then, we may already be twenty years late. And perhaps this is why one of the most important ideas in modern lipidology is not only: How low should LDL go? But: How early should we begin preventing cumulative exposure? A child with familial hypercholesterolemia may inherit not merely a laboratory abnormality. That child may inherit decades of accelerated arterial aging. If we wait for symptoms, we have confused diagnosis with prevention.
THIS WEEK, EUROPE IS DOING SOMETHING IMPORTANT
And here, the timing of your Congress could hardly be better. You are meeting during the first EU Cardiovascular Screening Week, launched on September 28. Its message is elegantly simple: Know your numbers. Blood pressure. Cholesterol. Blood glucose. Body weight and metabolic risk. The European Commission estimates that cardiovascular disease causes about 1.7 million deaths each year in the EU, and the Safe Hearts Plan aims to reduce premature cardiovascular mortality by 25% by 2035. That matters. But let us be clear. A screening week is not the destination. It is the start. Finding high LDL cholesterol helps only if treatment follows. Finding hypertension helps only if medicines remain available. Diagnosing diabetes helps only if long-term care exists. Identifying familial hypercholesterolemia helps only if we screen the family. Screening without treatment is merely better-organized disappointment.
THE SAFE HEARTS PLAN: FROM DOCUMENT TO DELIVERY
The European Union’s Safe Hearts Plan is historically significant as the first comprehensive EU-level cardiovascular health strategy. Its structure is sensible: Prevention. Early detection and screening. Treatment and care, including rehabilitation. And across all of these: digital innovation, research, knowledge, and the reduction of inequalities. But every policy document eventually faces the same test. Can Brussels reach the bedside? Can European policy reduce cardiovascular mortality in Lódź, Vilnius, Bratislava, Pristina, Bucharest, Sofia, and beyond? Can it reach the small towns? The primary-care clinics? The people who have never seen a cardiologist? That is where ILEP becomes so important. Because implementation cannot be imported as a finished product. It must be adapted locally.
FROM LIPIDS TO LEADERSHIP
Maciej Banach and colleagues have understood this. Your Congress brings together experts from more than 40 countries, and your program includes the European Program for Prevention and the Central European Prevention Initiative Alliance—a platform explicitly designed to facilitate the exchange of prevention strategies across Central and Eastern Europe. Look at the projects represented here: Familial hypercholesterolemia programs. Pediatric screening. National registries. Primary prevention initiatives. Risk-based prevention. These are not simply academic presentations. They are laboratories of implementation. One country learns from another. One registry becomes another country’s starting point. One successful screening model shortens somebody else’s learning curve. That is precisely how cardiovascular progress should travel. Not always from West to East. Not always from large nations to small ones. Good ideas should travel in every direction. Global health should never mean one part of the world exporting wisdom to another. It should mean the world learning from wherever wisdom is found.
ILEP AND WHF: WHAT SHOULD WE DO TOGETHER?
So, what should the partnership between ILEP and the World Heart Federation mean? Not another logo on another slide. Not another memorandum that everyone signs and nobody reads. Our collaboration should do something measurable. We should work together to: identify the cardiovascular prevention gaps that are greatest across Central and Eastern Europe; support national cardiovascular action plans; strengthen lipid detection and treatment; promote earlier identification of familial hypercholesterolemia; translate the Safe Hearts Plan into country-level implementation; share successful prevention models across borders; and ensure that innovation narrows cardiovascular inequalities rather than widening them. ILEP brings extraordinary scientific expertise in lipidology and prevention. WHF brings a global network spanning scientific societies, heart foundations, patient groups, advocates and policymakers. Together, perhaps we can shorten the distance between what science knows and what populations receive. That distance may be the most important cardiovascular measurement we have never included in a clinical trial.
THE SILENT INTERVAL
Let me return to Chopin. Anyone who loves music knows that music is not created only by notes. It is also created by the spaces between the notes. The pauses. The silence. Chopin understood silence beautifully. Cardiovascular disease has its silences too. The years before hypertension produced a stroke. The decades before elevated LDL produced myocardial infarction. The childhood before rheumatic fever became valve disease. The asymptomatic years before a cardiomyopathy declared itself through sudden death. The patients often felt nothing. But biology was not silent. We simply did not listen carefully enough. Perhaps prevention is the art of hearing disease before the patient could hear it. That is what screening does. That is what lipidology does. That is what imaging does. That is what genetics increasingly does. And that is what public health must do.
ONE FINAL THOUGHT
My dear ILEP friends, medicine is extraordinarily good at rescuing people from the cliff. We have catheter laboratories. Advanced imaging. Intensive care units. Mechanical circulatory support. Transplantation. Amazing drugs. And we should celebrate every one of those achievements. But the greatest cardiovascular system will not be the one with the finest ambulance waiting at the bottom of the cliff. It will be the one that prevents people from reaching the edge. That is prevention. That is equity. And, that is the common mission of ILEP and WHF.
So let Warsaw send a message to Europe: Let us finish the unfinished business of neglected cardiovascular disease. Let us identify the silent risk before catastrophe. Let us treat LDL before plaque becomes infarction. Let us find hypertension before it becomes stroke. Let us recognize inherited disease before tragedy becomes the first diagnostic test. Let us ensure that the Safe Hearts Plan becomes not simply a European policy, but a European reality. And let us insist that the place where someone is born never determines the length of the life they are permitted to live.
Chopin’s heart came home to Warsaw more than a century and a half ago. It has been protected with extraordinary care ever since. Today, our responsibility is larger. Millions of hearts are still waiting for that same determination. Let us protect them before they become memorials.
Dear Maciej, congratulations to you and the entire International Lipid Expert Panel. Thank you for what you are building. Professor Prabhakar carries the warmest greetings of the World Heart Federation to you in person. And I bring them from afar, half the way to Rio, for WHF’s World Congress of Cardiology, with enormous admiration, friendship and hope for what we can accomplish together. I wish you an inspiring Congress. And perhaps, in the spirit of Chopin:
Let us listen not only to the beats we can hear—
but to the disease that remains silent between them.
Thank you very much.
Jagat Narula, MD, PhD, MACC
President, World Heart Federation
International Lipid Expert Panel, Warsaw
2 October 2026
