Young heart attacks: Why fit-looking people can still face a hidden heart risk

Heart attacks are often associated with older age, but cardiovascular risk can begin much earlier. For South Asians, certain genetic and metabolic factors can increase the risk even when a person appears young or physically fit.

In an episode of Doctor vs Internet, Sonal Mehrotra Kapoor spoke with Dr. Ashok Seth, Chairman, Fortis Escorts Heart Institute, Okhla, New Delhi, about sudden cardiac events, hidden heart risks and preventive heart care.

Here are some of the key questions answered by the cardiologist.CAN A YOUNG, FIT PERSON STILL HAVE A HEART ATTACK?

Yes. Looking fit does not necessarily mean that the heart and arteries are healthy.

Dr. Seth explains that there is an important difference between building muscle and improving cardiovascular fitness. Someone may have a muscular physique while still having underlying risk factors for heart disease.

This is particularly relevant for South Asians, who can carry more visceral fat even when they do not appear overweight.WHY ARE SOUTH ASIANS AT HIGHER RISK OF HEART DISEASE?

One important factor is the way fat is distributed in the body.

South Asians can have a "thin outside, fat inside" pattern, where fat accumulates around organs such as the liver, heart and intestines. This visceral fat is associated with insulin resistance and unhealthy changes in cholesterol levels, which can contribute to the development of atherosclerosis.

Another risk factor discussed by Dr. Seth is lipoprotein(a), or Lp(a), a largely genetically determined type of lipoprotein associated with cardiovascular risk.DOES BMI REALLY TELL YOU IF YOU ARE OVERWEIGHT?

For South Asians, waist circumference can provide useful information about abdominal obesity and metabolic risk.

Dr. Seth points to 90 cm for men and 80 cm for women as important waist measurements for assessing obesity risk in the South Asian population.

This is one reason why simply looking at the weighing scale or BMI may not provide the complete picture of heart health.CAN GOING TO THE GYM PREVENT HEART ATTACKS?

Regular physical activity is important for cardiovascular health, but gym workouts alone do not automatically eliminate heart risk.

Dr Seth distinguishes between muscle-building exercises and cardiovascular fitness. A person may focus heavily on strength training and appearance while overlooking other aspects of heart health.

A balanced approach to exercise, along with monitoring blood pressure, cholesterol, blood sugar and other risk factors, is important.CAN HEAVY WEIGHTLIFTING TRIGGER A HEART ATTACK?

Sudden, intense exertion can place significant stress on the cardiovascular system.

Dr. Seth cautions that strenuous exercise, including heavy weightlifting, may trigger a cardiac event in people who already have an undiagnosed blockage or significant underlying risk. The risk can be particularly concerning among people who smoke or have other cardiovascular risk factors.

This does not mean that young people should avoid exercise. Rather, people with risk factors or symptoms should understand their cardiovascular health before pushing themselves into extreme workouts.WHAT IS LIPOPROTEIN(A), AND WHY DOES IT MATTER?

Lipoprotein(a), or Lp(a), is a type of lipoprotein in the blood that is strongly influenced by genetics.

According to Dr. Seth, elevated Lp(a) is an important cardiovascular risk factor, including among South Asians. Unlike some lifestyle-related risk factors, its levels are largely genetically determined.

People with a family history of premature heart disease may therefore need to discuss Lp(a) testing with their doctor.WHY CAN HEART DISEASE BE SILENT?

Heart disease does not always announce itself with dramatic symptoms.

A person can have underlying narrowing or blockage in the coronary arteries without obvious warning signs. This is why relying only on how young, active or healthy someone looks can be misleading.

Symptoms such as chest discomfort, unusual breathlessness, unexplained sweating, dizziness or discomfort spreading to the arm, shoulder, back, neck or jaw should not be casually dismissed, particularly when they occur during exertion.advertisementARE YOUNG PEOPLE BECOMING MORE AWARE OF HEART HEALTH?There is growing awareness among younger people about preventing conditions such as diabetes and hypertension rather than assuming that hereditary risk is unavoidable.

The focus is increasingly shifting from treating disease after it develops to identifying risk factors earlier.

That includes monitoring blood pressure, maintaining a healthy waist circumference, staying physically active, avoiding smoking and keeping track of metabolic and cholesterol-related risk factors.WHAT SHOULD YOUNG PEOPLE DO TO PROTECT THEIR HEART?

Heart health is not determined by age or appearance alone.

For people with risk factors, family history or symptoms, preventive evaluation can help identify problems earlier. Depending on an individual's history, doctors may consider measurements such as blood pressure, blood sugar, cholesterol levels and Lp(a), along with other tests when clinically appropriate.

The key message is simple: being young or looking fit does not make someone immune to cardiovascular disease. Understanding individual risk and addressing it early can be more useful than waiting for symptoms to appear.- EndsPublished By: Chaitanya DhawanPublished On: Sep 22, 2026 11:36 IST