Tamil Nadu’s cardiovascular mortality share rose from 21% of all deaths in 1990 to 36% in 2016, placing the state among the top three in India for cardiovascular disease (CVD) mortality. Ischaemic heart disease now accounts for the single largest share of years of life lost to premature death in the state. Overall mortality patterns across Tamil Nadu have remained relatively steady over the past decade, but this stability conceals an uncomfortable reality: heart disease continues to claim a growing and disproportionate share of that fixed number. Non-communicable diseases are responsible for more than 75% of all deaths in the state, and hypertension alone contributes to nearly 22% of them. The figures point to a population ageing into risk faster than its healthcare-seeking behaviour is adapting. Reading between these numbers reveals what they do not state directly: cardiovascular disease in Tamil Nadu is not an emerging threat. It is an established one, and the gap lies in e...