Heart disease was once considered a problem of later life. That assumption is quietly becoming outdated, and the shift deserves far more attention than it is currently getting.
There is a certain kind of incredulity that pervades the stories of people who suffer a cardiac event before the age of 40. Its characteristic signs can be found in the language used to describe what happened afterwards: “He was so fit.” “She runs every day.” “He had just undergone a medical check-up.” Or simply: “It all happened so unexpectedly.”
For many of us, there is an underlying belief that heart disease is something that will enter the story later—in our 50s and 60s, certainly not in our 30s.
That premise is not altogether wrong. Age is a dominant risk factor for cardiovascular disease. However, it is becoming increasingly inadequate, and the mismatch between our perception and the reality being seen in cardiology clinics in Indian cities is vast enough to warrant a deeper look.
A Shift That’s Hard to Ignore
Over the past decade, a distinct and increasingly common pattern has emerged in cardiology practices across Delhi-NCR—and indeed, other major Indian cities. It does not comfortably square with established preconceptions about who should expect heart attacks, arrhythmias and signs of heart failure, and when.
It is no longer unusual for heart failure, a rhythm disturbance or an early warning sign to arrive in the mid-thirties, and sometimes even the late twenties. This trend is not confined to India, but the speed and scale of its emergence in urban India have drawn particular concern.
South Asians have long been known to experience cardiovascular disease earlier and, often, more severely than many other populations, for reasons that are not always entirely clear. But when an apparently healthy person in their early thirties presents with serious cardiac warning signs, it is, in the truest sense, something worthy of attention.
And it is not merely about how early these events are occurring, but also how frequently they are being seen in people who appear to have little or no obvious risk. These are individuals with no family history of cardiac disease, who exercise regularly, do not smoke and whose health profiles might otherwise raise no immediate concern.
The Familiar Risk Factors, Arriving Earlier
Certainly, some of what we are observing is not mysterious. These are the same well-known cardiovascular risk factors, simply appearing earlier in life than we traditionally considered typical.
Diabetes, as well as pre-diabetes, historically associated with middle age and beyond, is now more routinely being discovered in people in their 20s and 30s. Hypertension, once rarely considered before the age of 40, is now often discovered incidentally during a routine physical examination or a check-up for an unrelated issue because it usually causes no symptoms at this stage.
The same pattern is playing out with high cholesterol, particularly elevated LDL and low HDL levels.
Part of the explanation lies in the lifestyle changes that have rapidly taken hold over the past two decades. Diets in urban India have changed significantly to include more processed foods, refined carbohydrates and energy-dense meals. At the same time, physical activity levels have declined, partly as a predictable consequence of desk-bound jobs, long commutes and increasingly sedentary lifestyles.
These are behaviours that once took a lifetime to accumulate but are now becoming evident by early adulthood and often persist for years.
Add to this the issue of obesity, particularly abdominal obesity and visceral fat, which are prevalent among South Asians and can carry significant cardiovascular risk even at body weights considered normal according to conventional international criteria. As a result, many young adults who do not consider themselves overweight may still be carrying substantial cardiac risk.
Stress, Sleep and the Modern Workday
Alongside the factors we can measure—cholesterol, hypertension and diabetes—lies a second set of influences that are less easily quantified but are being discussed with increasing frequency in cardiology circles.
Two major drivers are chronic stress and sleep fragmentation, both of which have, over the past decade, become almost synonymous with urban professional life.
Chronic job-related stress that persists for years without adequate respite can contribute to cardiovascular disease through multiple mechanisms. Prolonged elevation of the stress hormone cortisol can contribute to persistently high blood pressure and heart rate, greater systemic inflammation and an overall decline in the body’s ability to return to a genuine state of calm.
These are not new insights, but the scale of accumulation has become significant for a workforce spending more time at work, with the lines between professional and private life increasingly blurred and a work culture that often demands constant availability.
Sleep deprivation exacerbates this considerably.
Poor-quality or chronically insufficient sleep can compromise effective blood pressure regulation and glycaemic control while increasing inflammatory markers, all of which add to cardiovascular risk over time. Among young urban workers in the NCR, sleep often appears to be the first casualty of late work, increased screen time and the limited free time available at the end of a busy day.
Substance Use, Old and New
Smoking continues to be a prominent and well-documented risk factor for cardiovascular disease. While smoking rates have declined in some groups, alternative nicotine sources, including e-cigarettes and various forms of smokeless tobacco, have created a changing risk profile that has not yet been comprehensively evaluated over the long term.
Young urban professionals have also shown changing patterns of alcohol consumption over the past decade, with drinking at social events becoming a more customary and frequent part of social and professional life than it may have been for previous generations.
While the cardiovascular impact of moderate drinking remains an area of medical debate, heavier and more frequent drinking carries more well-established risks, including increased blood pressure and a greater risk of arrhythmias in susceptible individuals.
Recreational stimulant use, though not commonly discussed in relation to cardiovascular risk among the general population, periodically emerges as a concern among younger patients. It can present a disproportionately high acute cardiac risk that is considerably underappreciated by those currently using such substances.
The Genetics That Can’t Be Outrun by Lifestyle Alone
Not everyone develops heart disease early because they have been burning the candle at both ends.
We now understand that genetic factors may be responsible for a larger proportion of early cases than previously thought. Earlier disease onset and more aggressive cardiovascular presentations have long been recognised among many individuals of South Asian descent, regardless of their weight, diet or activity levels.
A few uncommon genetic disorders, such as familial hypercholesterolaemia—in which a genetic defect leads to significantly elevated cholesterol from a young age—can drastically increase a person’s cardiac risk despite an otherwise outwardly healthy lifestyle.
Family history, too, plays a stronger role than many people realise. A parent or sibling having a heart attack at an early age is not something to dismiss as unrelated to one’s own risk.
Genetic influence is important for another reason: it helps explain how a younger, apparently fit and healthy person may suffer a cardiovascular event.
In young adults, a routine assessment should include careful attention to personal and family cardiac history and, where necessary, targeted tests.
Why It’s Often Missed Until It’s Serious
Perhaps even more disheartening is how often early warning symptoms in young patients are ignored—sometimes by patients themselves and, at other times, because of deeply held beliefs about whom heart disease typically affects.
Young people experiencing chest pain, unexplained fatigue or breathlessness on exertion may simply be labelled as stressed, anxious or out of shape rather than being considered for a possible cardiac cause.
In people in their 20s and 30s who otherwise appear well, cardiac symptoms can be dismissed or investigated later because heart disease has historically been associated with older age groups.
There should be no such assumptions. No patient’s concerns should be belittled, ridiculed or put off simply because they are young.
It is not necessarily that doctors are unable to recognise cardiac symptoms when they are properly described. The problem can also be a lack of proactive investigation into possible cardiac causes until the situation becomes more acute or blood tests and ECG findings finally provide confirmation.
A person in their 20s or 30s who does not appear obese may be more likely to attribute chest tightness to indigestion or muscle strain and delay even the first medical visit, let alone a cardiac consultation.
What Actually Warrants Attention
None of this means that every ache or moment of tiredness in a young person must be early heart disease. That kind of scare-mongering helps nobody and mostly creates more anxiety than action.
However, there are certain signs that deserve proper evaluation rather than dismissal or self-diagnosis.
Discomfort in the chest—whether experienced as pain, pressure, tightness or simply a sense of heaviness—that is brought on by activity and resolves when the activity stops deserves attention. This association with exertion can be an important identifier of a potential cardiac issue and may differ from discomfort related to muscular problems or indigestion.
Shortness of breath that is beyond what would normally be expected for exertion, particularly when it represents a genuine change from a person’s usual fitness, should not simply be dismissed as being “out of shape”.
Palpitations—a sensation of the heart racing, missing a beat or fluttering—should be evaluated when they recur and are associated with dizziness or light-headedness, even though they can be common as an isolated symptom.
Episodes of unexpected fainting or near-fainting, particularly when related to exercise, should be taken more seriously and evaluated promptly rather than simply observed to “see what happens”.
Family history is also an important factor. A parent, sibling or other family member experiencing a heart attack, cardiac arrest or sudden unexplained death at a relatively young age warrants proactive evaluation, even in the absence of symptoms, rather than waiting until something happens.
The Screening Conversation
A key part of addressing this trend may be redefining the appropriate time to begin thinking about cardiovascular screening.
Standardised assessments of risk—including blood pressure, lipids and blood sugar—have historically not been taken as seriously until closer to the age of 40, unless an individual had known risk factors or a family history suggesting elevated cardiovascular risk.
That approach now appears increasingly outdated in the context of current clinical observations.
A basic work-up—including blood pressure measurement, fasting blood sugar with HbA1c and a lipid profile—may be worth considering from the mid-to-late 20s, particularly for city dwellers with low levels of physical activity, those with a family history of cardiovascular disease or diabetes, or those with risk factors such as obesity or cigarette use.
These tests are relatively inexpensive and widely available and may help identify risk years before it develops into overt disease, creating an important window for intervention.
More targeted or advanced screening, such as coronary calcium scoring or specialised lipid testing, may be discussed with a cardiologist in people with a strong family history of very early cardiac events. Such tests are generally considered on an individual basis.
What Can Actually Be Changed
What is heartening is that a large proportion of cardiovascular risk, including risk that appears relatively early in life, remains amenable to change—as long as we are reasonably consistent.
Walking regularly, even in moderate amounts over a lifetime, can substantially reduce cumulative cardiovascular risk. General recommendations for moderate-intensity cardiovascular exercise of about 150 minutes a week are something many people can realistically achieve without completely upending their lives.
Healthy eating habits—such as limiting ultra-processed foods, added sugars and excessive refined sodium intake while increasing the consumption of whole, fibre-rich foods and healthy fats—have repeatedly been associated with long-term cardiovascular health.
Poor-quality sleep does not receive nearly enough attention as a general health issue. Prioritising consistent and sufficient sleep should not be regarded as a lifestyle extra. In many ways, it may be as important as diet and exercise, even though mainstream health advice does not always frame it that way.
Addressing chronic stress also remains profoundly important, while recognising that telling someone simply to “chill out and manage your stress” is often both unhelpful and impractical given real work and family pressures.
Consistent sleep, regular exercise, good social connections, some form of self-care and appropriate boundaries remain among the more durable approaches available. Smoking cessation and sensible limits on alcohol can also be tremendously beneficial.
In fact, cardiovascular risk can begin to decrease relatively quickly after smoking cessation, which often surprises people who believe the damage is permanently fixed once they have smoked.
Reframing the Timeline
Perhaps the key change required here is not clinical but cultural.
The way many of us think about heart health has largely been: “That is an issue for later, when I’m 40-odd and several risk factors have probably already had two or three uninterrupted decades to build.”
When cardiovascular health becomes something people can reasonably begin thinking about from their 20s—and this does not mean making 25-year-olds think of themselves as cardiac patients—it creates a legitimate window for pragmatic intervention.
That can make a real difference to how things eventually play out.
Long-term cardiovascular protection through healthy habits, relevant screening and greater awareness becomes far more effective when embraced early, rather than being triggered by the shock of a diagnosis.
Young hearts are not necessarily failing because of a sudden, spontaneous illness. They are often responding to a specific mix of factors, including changing lifestyles, unaddressed chronic stress, altered sleep patterns, changing diets and long-standing genetic risk—with modern urban life intensifying their interplay.
The encouraging part is that much of this risk may be manageable when addressed early, rather than deferred to some more convenient stage of life. n
This article is intended for information and awareness only and cannot replace professional medical advice or diagnosis. If you experience symptoms such as chest pain, difficulty breathing, palpitations, fainting or a sensation of passing out, please consult a medical doctor immediately.