Aperson may go to the gym, play sport every week, maintain a healthy weight and still have serious heart disease without knowing it. UAE cardiologists say this is one of the reasons people in their 30s and 40s should not assume that being active alone protects them from heart problems.
"Looking fit is not the same as being free of cardiovascular risk," said Dr Yogeeswari Vellore Satyanarayanan, specialist cardiology at Medcare Royal Speciality Hospital. She said that high blood pressure, diabetes and cholesterol problems can remain silent for years, while inherited conditions can also raise a person's risk even if they exercise regularly.
"Conditions such as familial hypercholesterolaemia and high lipoprotein(a), or Lp(a), may increase the risk of heart disease without causing obvious symptoms," she said. "Knowing personal risk factors and getting the right health checks can therefore help identify problems before a major cardiac event."
Dr Hesham Tayel, consultant cardiologist at International Modern Hospital, said he has been seeing more patients in their 30s and 40s with significant coronary artery disease.
“What is surprising is that some of them look completely healthy. They exercise, have normal weight, and do not think they are at risk,” he said.
He recalled patients who came to hospital after their first episode of chest pain and were shocked to learn that they had severe blockages that needed urgent treatment.
“Some had already been going to the gym regularly and believed they were too young to have heart disease,” he said. “The important message is that looking fit does not always mean the arteries are healthy.”
Family history, smoking or vaping, diabetes, high blood pressure, chronic stress, poor sleep and inherited cholesterol problems are among the risks doctors may find in these patients.
Dr Tayel said routine cholesterol tests also do not always show the full picture. A person can have cholesterol levels that appear normal while still having a raised Lp(a), an inherited risk factor linked to heart attack and stroke.
He said ApoB can also help doctors understand the number of harmful cholesterol particles in the blood. For selected patients, a coronary calcium scan may reveal early plaque build-up in the arteries even when other tests appear reassuring.
Dr Austin Mohan Komaranchath, HOD and specialist interventional cardiologist at NMC Specialty Hospital, Al Ain, said one of the main problems he sees is that many younger adults are simply not being screened.
“I see people in their 30s and 40s who exercise, look fit and feel completely healthy, yet have significant coronary disease,” he said. “Being physically active is extremely important, but it does not protect you completely from genetic risk factors, high blood pressure or high cholesterol.”
Blood pressure is one area that is often ignored, he said. Some young people do not check it regularly, while others discover that it is high but do not take it seriously.
There is also a fear among some patients that once they start blood-pressure medication, they will have to remain on it for life. Dr Austin said this can lead to years of uncontrolled blood pressure and damage to the arteries.
He also said that people should not be satisfied simply because their cholesterol level has fallen. The important question is whether it has reached the right level for their individual risk.
Another test that can help selected patients is coronary calcium scoring. Dr Austin said that in his own practice, around 30 to 40 patients over the past year were found to have abnormal calcium scores despite reassuring stress tests and echocardiograms.
A stress test and a calcium scan, he explained, answer different questions. A reassuring stress test does not necessarily mean that there is no plaque developing in the coronary arteries.
