Hyderabad-based cardiologist Dr Syed Akram Ali recently shared a worrying case of a 37-year-old who, despite running 5 km daily, eating no junk, sleeping on time, and having no vices, needed two stent placements in his heart. “A healthy man with no junk food, ran 5 km had 2 stents. He ran 5 km every morning. He avoided junk food. He didn’t smoke, didn’t drink, slept on time, did everything ‘right.’ Yet last month, this 37-year-old Hyderabad man landed in the cath lab with chest pressure and left arm heaviness…An angiography showed two major blockages. He needed two stents,” Dr Ali noted in an Instagram post.
According to the expert, the real hidden causes that most people never check are genetic/family risk (the silent killer). “If your father/uncle had early heart issues, your risk is 2–3× higher — even if you’re fit, lean, and active.” Another reason could be lipoprotein(a) — “the most dangerous cholesterol (not checked in routine tests)”. “Normal lipid profile is NOT enough. Lp(a) is purely genetic. High levels clog arteries even if LDL is ‘normal,” added Dr Ali.
DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.
High stress + corporate lifestyle is another reason. “5 km running is not equal to stress management. Stress increases adrenaline, blood pressure, inflammation and causes microplaque formation.”
Inflammation (CRP) is also to blame. “Many ‘fit’ people have hidden inflammation, which leads to faster artery damage. Not measured in regular checkups,” said Dr Ali.
Poor sleep quality like sleeping 6 hours with screens till midnight = metabolic strain. “Raises cortisol, thickens blood, increases plaque instability,” said Dr Ali.
Here’s what you should consider (Photo: Getty Images/Thinkstock)
Misleading fitness beliefs are to be blamed, too. “Running keeps you fit. It doesn’t guarantee clean arteries. Heart disease = genes + lifestyle + inflammation + stress + sleep + lipoprotein,” said Dr Ali.
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Dr Ali listed the tests every Indian above 25 must do:
- Lipoprotein(a)
- HS-CRP (inflammation marker)
- ApoB
- HbA1c
- Fasting insulin
- VitD
- Homocysteine
- TMT(If symptoms)
- Coronary calcium score (above 35 years)
To verify, we consulted with Dr Parin Sangoi, consultant, interventional cardiologist, Wockhardt Hospitals, Mumbai Central, who told indianexpress.com that physical fitness does not guarantee good arterial health. “A person may have good endurance but still develop plaque in the coronary arteries. Genetic factors, such as family history or high Lipoprotein(a) levels, can speed up plaque formation even when cholesterol levels seem normal,” said Dr Sangoi.
Several hidden factors often go unchecked. Lipoprotein(a), a purely genetic cholesterol particle, can silently clog arteries even when routine cholesterol levels are normal.
Dr Sangoi concurred that lipoprotein(a), or Lp(a), is a cholesterol particle determined by genetics that does not appear on routine lipid tests. “High levels significantly raise the risk of early heart attacks and serious artery blockages. Because it is inherited, even young, lean individuals can be affected without any warning signs,” said Dr Sangoi.
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Chronic stress, especially in corporate lifestyles, increases blood pressure, inflammation, and plaque formation, which exercise alone cannot undo, said Dr Rahul Gupta, director and cardiologist at Gleneagles Hospital, Parel. “Poor sleep quality, constant screen exposure, and untreated inflammation further weaken artery health. Many ‘fit’ individuals also have high CRP levels, insulin resistance, or elevated homocysteine, none of which show up in basic tests. This is why a normal lipid profile or regular running is not enough,” said Dr Gupta.
Markers such as HS-CRP for inflammation, ApoB, HbA1c, fasting insulin, and homocysteine provide a more comprehensive view of cardiovascular risk. In certain individuals, a coronary calcium score can identify early plaque even before symptoms appear, said Dr Sangoi.
Emphasising that heart disease results from genes, inflammation, stress, sleep, and metabolic health combined, Dr Gupta said early, advanced testing and preventive evaluation are essential to protect the heart truly.
DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.