Rachel V Thomas

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World Heart Day: You Feel Healthy. But Plaque May Already Be Building In Your Arteries In Your 20s

You can exercise regularly, eat reasonably well and have no obvious symptoms — yet still have <span>plaque</span> building up inside your <span>arteries</span>. 

The process called <span>atherosclerosis</span> is often slow and silent, with symptoms appearing only after plaque significantly affects blood flow — sometimes with a <span><a href="https://www.healthandme.com/health/heart-attack">heart attack</a></span> or stroke.

A study published earlier this month in <em>The New England Journal of Medicine</em> (NEJM) found that plaque buildup can begin decades before symptoms appear. Researchers detected atherosclerosis in many apparently healthy young adults, including those in their 20s.

<h2>Atherosclerosis Can Start Decades Before Symptoms</h2>

The NEJM study showed that signs of hidden atherosclerosis could be detected in approximately one in 13 people aged 18–29. Among those aged 60–70, nine out of 10 showed signs of atherosclerosis.

Dr. Robert Grant, St. George’s University School of Medicine, Grenada, West Indies, told <strong><em>HealthandMe </em></strong>that the most important message is that atherosclerotic cardiovascular disease often begins decades before symptoms appear. Heart attacks and strokes are usually late manifestations of a process that develops gradually over many years.

“Atherosclerosis is not exclusively a disease of older adults. Clinical complications remain predominantly diseases of older adults. The pathological process often starts much earlier than the clinical disease becomes evident," he said.

The study therefore shifts our thinking from "atherosclerosis is an old-age disease" to "atherosclerosis is a lifelong disease that becomes clinically important with advancing age," he added.

<h2>Can Exercise And A Healthy Diet Protect?</h2>

Regular exercise, a healthy diet, avoiding smoking, maintaining a healthy weight, and good sleep remain important preventive measures, said Dr. Robert.

“These habits lower LDL cholesterol, improve blood pressure, reduce inflammation, improve insulin sensitivity, and substantially reduce cardiovascular event rates," he said. “They are foundational and should not be minimized.”

However, healthy lifestyles do not guarantee the absence of atherosclerosis. Other risk factors include:

<ul><li>Genetic predisposition and family history</li><li>Elevated lipoprotein(a) [Lp(a)]</li><li>Insulin resistance or diabetes</li><li>Previously elevated LDL levels during earlier life</li><li>Hypertension that has gone undetected or untreated</li></ul>

Dr. Rajat Mohan, Senior Consultant Cardiologist at Sir Ganga Ram Hospital, also stressed that people who exercise and eat in moderation can still develop coronary disease because of other risk factors, including genetic tendencies.

He also emphasized the need to check cholesterol levels and avoid smoking.

<h2>Why Indians May Be More Vulnerable</h2>

Coronary artery disease has a high burden in the Indian population, with diabetes, family history, smoking and tobacco use among the factors contributing to risk, Dr. Rajat told <strong><em>HealthandMe</em></strong>.

"Diabetes is a precursor for developing coronary artery disease," he said.

Dr. Ramakanta Panda, renowned cardiac surgeon and Chairman, Asian Heart Institute, Mumbai, also pointed to studies suggesting greater vulnerability to early atherosclerosis among Indians.

Referring to the INTERHEART study, he said that Indians get their first heart attack 5-6 years earlier than people from other regions, and a UK study found double the risk compared with Europeans.

<h2>Can Normal Cholesterol And Blood Pressure Be Reassuring?</h2>

“Yes. The "normal" LDL range is not truly safe for arteries. In US adults without traditional risk factors, coronary atherosclerosis rose from 13.2% when LDL-C was below 70 mg/dL to 48.2% when it was 160 mg/dL or higher. Non-HDL cholesterol and apoB showed similar associations," Dr. Ramakanta told <strong><em>HealthandMe</em></strong>.

He added that beyond standard readings, doctors should consider:

<ul><li>apoB and lipoprotein(a)</li><li>HbA1c and insulin resistance</li><li>Waist circumference and fatty liver</li><li>hsCRP</li><li>Premature family history</li><li>Kidney disease and pregnancy complications</li><li>Where appropriate, calcium scoring</li></ul>

Dr. Ramakanta said that mass screening has not been shown to reduce death rates significantly. However, targeted screening or testing can be helpful. For an apparently healthy person with no symptoms, a sensible approach is:

<ul><li>Blood pressure</li><li>Fasting glucose/HbA1c</li><li>Lipid profile, particularly LDL</li><li>Weight/BMI and waist circumference</li><li>Smoking/tobacco, physical activity, diet and family history of premature heart disease</li><li>Assess the person’s overall cardiovascular risk and treat modifiable risk factors accordingly</li></ul>

"The ESC specifically recommends systematic risk assessment in people without known cardiovascular disease. I would not recommend routine ECG, treadmill testing, echocardiography, or coronary CT for every asymptomatic individual unless they have risk factors.”

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You can exercise regularly, eat reasonably well and have no obvious symptoms — yet still have plaque building up inside your arteries. The process called atherosclerosis is often slow and silent, with symptoms appearing only after plaque significantly affects blood flow — sometimes with a heart attack or stroke.A study published earlier this month in The New England Journal of Medicine (NEJM) found that plaque buildup can begin decades before symptoms appear. Researchers detected atherosclerosis in many apparently healthy young adults, including those in their 20s.Atherosclerosis Can Start Decades Before SymptomsThe NEJM study showed that signs of hidden atherosclerosis could be detected in approximately one in 13 people aged 18–29. Among those aged 60–70, nine out of 10 showed signs of atherosclerosis.Dr. Robert Grant, St. George’s University School of Medicine, Grenada, West Indies, told HealthandMe that the most important message is that atherosclerotic cardiovascular disease often begins decades before symptoms appear. Heart attacks and strokes are usually late manifestations of a process that develops gradually over many years.“Atherosclerosis is not exclusively a disease of older adults. Clinical complications remain predominantly diseases of older adults. The pathological process often starts much earlier than the clinical disease becomes evident," he said.The study therefore shifts our thinking from "atherosclerosis is an old-age disease" to "atherosclerosis is a lifelong disease that becomes clinically important with advancing age," he added.Can Exercise And A Healthy Diet Protect?Regular exercise, a healthy diet, avoiding smoking, maintaining a healthy weight, and good sleep remain important preventive measures, said Dr. Robert.“These habits lower LDL cholesterol, improve blood pressure, reduce inflammation, improve insulin sensitivity, and substantially reduce cardiovascular event rates," he said. “They are foundational and should not be minimized.”However, healthy lifestyles do not guarantee the absence of atherosclerosis. Other risk factors include:Genetic predisposition and family historyElevated lipoprotein(a) [Lp(a)]Insulin resistance or diabetesPreviously elevated LDL levels during earlier lifeHypertension that has gone undetected or untreatedDr. Rajat Mohan, Senior Consultant Cardiologist at Sir Ganga Ram Hospital, also stressed that people who exercise and eat in moderation can still develop coronary disease because of other risk factors, including genetic tendencies.He also emphasized the need to check cholesterol levels and avoid smoking.Why Indians May Be More VulnerableCoronary artery disease has a high burden in the Indian population, with diabetes, family history, smoking and tobacco use among the factors contributing to risk, Dr. Rajat told HealthandMe."Diabetes is a precursor for developing coronary artery disease," he said.Dr. Ramakanta Panda, renowned cardiac surgeon and Chairman, Asian Heart Institute, Mumbai, also pointed to studies suggesting greater vulnerability to early atherosclerosis among Indians.Referring to the INTERHEART study, he said that Indians get their first heart attack 5-6 years earlier than people from other regions, and a UK study found double the risk compared with Europeans.Can Normal Cholesterol And Blood Pressure Be Reassuring?“Yes. The "normal" LDL range is not truly safe for arteries. In US adults without traditional risk factors, coronary atherosclerosis rose from 13.2% when LDL-C was below 70 mg/dL to 48.2% when it was 160 mg/dL or higher. Non-HDL cholesterol and apoB showed similar associations," Dr. Ramakanta told HealthandMe.He added that beyond standard readings, doctors should consider:apoB and lipoprotein(a)HbA1c and insulin resistanceWaist circumference and fatty liverhsCRPPremature family historyKidney disease and pregnancy complicationsWhere appropriate, calcium scoringShould Screening Be Universal?Dr. Ramakanta said that mass screening has not been shown to reduce death rates significantly. However, targeted screening or testing can be helpful. For an apparently healthy person with no symptoms, a sensible approach is:Blood pressureFasting glucose/HbA1cLipid profile, particularly LDLWeight/BMI and waist circumferenceSmoking/tobacco, physical activity, diet and family history of premature heart diseaseAssess the person’s overall cardiovascular risk and treat modifiable risk factors accordingly"The ESC specifically recommends systematic risk assessment in people without known cardiovascular disease. I would not recommend routine ECG, treadmill testing, echocardiography, or coronary CT for every asymptomatic individual unless they have risk factors.”

world heart day: you feel healthy. but plaque may already be building in your arteries in your 20s

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World Heart Day: You Feel Healthy. But Plaque May Already Be Building In Your Arteries In Your 20s

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World Heart Day: You Feel Healthy. But Plaque May Already Be Building In Your Arteries In Your 20s

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