Dr Narayan Bhat M

An alarming health trend has emerged over the last several years: young, seemingly fit Indians in their 20s and 30s are suffering from sudden, fatal heart attacks. This cardiac crisis is not a random coincidence; it is the result of a dangerous intersection between genetic vulnerability, lifestyle choices, and unscientific fitness habits.

Indians face a distinct genetic predisposition to premature Coronary Artery Disease (CAD). Indians suffer heart attacks 10 years earlier than other global populations. This vulnerability is driven by several factors

-          Diabetes, high blood pressure, smoking, family history of heart problem are important causes of heart attack in young.

-          Smaller Coronary Arteries: Indians possess smaller, thinner blood vessels, making them far more susceptible to early blockages.

-          The "Thin-Fat" Indian body type: Many Indians are thin, but have potbelly. They carry hidden fat around internal organs despite having normal weight. This triggers severe insulin resistance, metabolic syndrome, and high levels of Lipoprotein (a), a highly atherogenic (plaque-causing) genetic cholesterol marker.

Changed dietary habits

Modern dietary shifts have accelerated this genetic risk. Diets heavy in refined carbohydrates, deep-fried street foods containing Trans fats, and hidden sugars damage the vascular lining. Refined carbohydrates — white rice, Maida-based breads, biscuits, and packaged snacks — spike blood sugar and triglycerides. Tran’s fats from Vanaspati and re-used cooking oils inflame arterial walls. Excess salt in pickles, papads, and processed foods raises blood pressure. Even "healthy" ghee in excess loads up saturated fat in those already genetically at risk. Furthermore, the extreme pressure to build muscle fast has led to a dangerous reliance on unverified protein supplements, anabolic steroids, and high-caffeine pre-workout stimulants. These substances thicken the blood, elevate blood pressure, and disturb the heart's electrical rhythms. Most Indians are ‘couch potatoes “- they eat all junk food, travel in bikes or car, and do not exercise.

When combined with chronic work-related stress, poor sleep cycles, and heavy smoking or vaping or chewing tobacco, the body enters a state of chronic, low-grade vascular inflammation.

The Gym Paradox

While moderate exercise protects the heart, intense, unscientific workouts or weightlifting can trigger catastrophic events. In a person with a sedentary background or an undiagnosed, asymptomatic blockage, jumping directly into high-intensity interval training (HIIT) or lifting maximum weights causes a massive surge in blood pressure. This mechanical stress can cause a soft, unstable cholesterol plaque inside the narrow artery to rupture, forming a sudden blood clot that completely cuts off blood supply to the heart muscle.

-          High-Risk Habits

-          Chronic stress & burnout

-          Sleep deprivation (<6 hrs)

-          Smoking /chewing tobacco

-          Sedentary desk lifestyle

-          Binge drinking on weekends

-          Skipping annual check-ups

-          Unmanaged diabetes/BP

-          Ignoring early warning signs

-          Recognizing the Warning Signs

Never dismiss unusual bodily discomfort as mere gym fatigue or acidity. Immediate evaluation is required if you experience:

-          Chest Discomfort: A heavy, squeezing pressure, fullness, or burning sensation in the center of the chest. CAN OCCUR on walking or exertion for initial few months or can get burning pain at rest also. Some may feel breathless on exertion or easy fatigue.

-          Radiation of Pain: Discomfort that travels down the left arm, or spreads to the neck, jaw, back, or stomach.

-          Atypical Symptoms: Unexplained, profuse cold sweating, sudden dizziness, or shortness of breath while performing routine activities.

Essential Screening Tests

If you are over the age of 30, have a family history of heart disease, or plan to begin a high-intensity gym regimen, undergo these basic cardiac evaluations:

1. Electrocardiogram (ECG) & 2D Echocardiogram: To check the heart’s electrical baseline rhythms and evaluate its structural pumping efficiency.

2. Advanced Lipid Profile & HbA1c: To measure standard cholesterol alongside specialized risk markers like Apolipoprotein B, LP [a], **hs-CRP (inflammation), and hba1c.

3. Treadmill Test (TMT) / Stress Test: Evaluates how your blood vessels and heart muscles respond under physical exertion.

4. CT Coronary Calcium Scoring: A non-invasive scan that detects early calcium deposits and hidden plaque buildup long before symptoms appear.

(Dr Narayan Bhat M, Consultant - Cardiology, KMC Hospital, Mangaluru)