For decades, the threat of heart disease has been viewed as an adult, middle-aged, or even elderly problem. Today, however, the perception is rapidly changing, especially as we see an increasing threat of heart disease in the young, many of whom may seem physically active, healthy, and youthful.
The situation, therefore, necessitates a more proactive approach, especially in light of the updated global cholesterol management guidelines that advocate earlier screening and lifetime risk assessment.
The myth of healthy equals safe
One common myth is that being youthful and physically active inherently protects against heart disease. In fact, several underlying causes can subtly raise the risk of cardiovascular disease:
- Genetic predisposition: A family history of early heart disease significantly raises risk even in the absence of symptoms.
- Hidden metabolic problems: Conditions such as borderline diabetes, insulin resistance, and high cholesterol are not being addressed in young individuals.
- Chronic stress and poor sleep: Urban lives, demanding work schedules, and excessive digital exposure can exacerbate hormonal imbalances and inflammation.
This group of young and physically active 'healthy' people who may still be at risk of heart disease is often described as 'fit but at risk'.
Why early screening matters
The evolving approach to cardiovascular care emphasises prevention rather than reaction. Instead of waiting for symptoms to appear, young adults, especially those above 19, should start assessing their heart health early.
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Key evaluations include:
- Lipid profile tests to identify the level of cholesterol
- Monitoring of blood pressure to identify hypertension
- Monitoring of sugar levels to identify the risks of diabetes
- Identify the risks by reviewing the family history
In some cases, additional markers such as inflammatory markers or more advanced lipid profiles can be used to provide a more complete picture of the patient’s risks. Whereas, functional assessments such as cardiac stress tests may also be advised to evaluate how the heart performs under exertion.
Advanced screening tools such as lipoprotein(a), high-sensitivity CRP (hs-CRP), and, in select high-risk cases, imaging tests like CT angiography may be considered—though these should be used judiciously and only when clinically indicated. Certain tools, such as coronary calcium scoring, may have limited relevance in younger individuals and should not be routinely relied upon. Regular annual check-ups from the age of 18–19 are strongly recommended, especially for those with a family history of heart disease.
Understanding lifetime risk
Traditionally, heart disease risk was assessed over a 10-year period, but this often underestimates danger in young adults. A lifetime risk approach provides a clearer picture, helping identify those who may need early intervention. For example, mildly elevated cholesterol may seem insignificant in the short term, but when combined with family history, it can significantly increase long-term risk.
While risk factors remain the same as in older adults—non-modifiable (age, heredity) and modifiable (diabetes, smoking, high cholesterol, hypertension, obesity, sedentary lifestyle, and stress)—their impact is now occurring earlier. Among these, stress is a key trigger in younger populations, fueled by academic pressure, early career demands, and personal challenges, and further worsened by poor sleep, irregular routines, and unhealthy diets.
Smoking, stress, and diabetes are often referred to as the 'three major demons' of heart disease in youth, frequently posing a greater risk than high cholesterol alone.
Moving from awareness to action
Preventive cardiology is not about fear, but about empowering individuals to take charge of their health—because simple, consistent habits can make a meaningful difference. These include following a balanced, high-fibre diet low in trans fats, staying physically active with both cardio and strength training, prioritising sleep, managing stress, avoiding tobacco, and limiting alcohol.
For high-risk individuals, early medical interventions—such as cholesterol-lowering medications like statins—may be recommended, based on a personalised assessment of overall risk factors.
Among all modifiable risks, stress, diabetes, and smoking emerge as the most critical contributors to heart disease in younger individuals—often having a greater impact than even high cholesterol. Stress, for example, is a multifaceted problem induced by early work expectations, academic obligations, and personal issues.
A shift towards preventive mindsets
India is at a crucial juncture, with lifestyle-related illnesses affecting younger populations, making it essential to shift from a reactive approach to one focused on prevention and early detection.
People should view health as more than just physical looks when defining what being healthy means. People achieve their best health when they understand their body functions, identify their personal health problems, and take informed steps to protect their future well-being.
The combination of early detection with immediate treatment will successfully decrease cardiovascular disease risks, while helping young people achieve better heart health than staying regularly physically active.
(The author is a Consultant - Adult Cardiology, Manipal Hospital, Old Airport Road)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
