Staying active may not fully protect the heart, as high blood pressure, cholesterol and inherited risks can develop silently for years.
A person can exercise regularly, play sports every week and maintain a healthy weight yet still have underlying heart disease without realising it. UAE cardiologists say this is why adults in their 30s and 40s should not assume that an active lifestyle alone protects them from cardiovascular problems.
“Looking fit is not the same as being free of cardiovascular risk,” said Dr Yogeeswari Vellore Satyanarayanan, a specialist in cardiology at Medcare Royal Speciality Hospital.
She explained that conditions such as high blood pressure, diabetes and abnormal cholesterol levels can develop silently over several years. Genetic factors can also increase the risk of heart disease, even among people who exercise regularly and appear physically fit.
“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.
Understanding individual risk factors and undergoing appropriate health checks can therefore help detect potential problems early, before they lead to a serious cardiac event.
‘They believed they were too young’
Dr Hesham Tayel, consultant cardiologist at International Modern Hospital, said he is seeing more patients in their 30s and 40s diagnosed with significant coronary artery disease — including some who appear otherwise healthy.
“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 arriving at hospital after experiencing chest pain for the first time, only to discover they had severe arterial blockages requiring urgent treatment.
“Some had already been going to the gym regularly and believed they were too young to have heart disease,” Dr Tayel said. “The important message is that looking fit does not always mean the arteries are healthy.”
Doctors may identify a range of underlying risk factors in such patients, including family history, smoking or vaping, diabetes, high blood pressure, chronic stress, poor sleep and inherited cholesterol disorders.
Dr Tayel noted that standard cholesterol tests may not always provide the complete picture. Someone can have apparently normal cholesterol levels while still having elevated lipoprotein(a), or Lp(a), an inherited risk factor associated with heart attack and stroke.
Another marker, ApoB, can help doctors assess the number of potentially harmful cholesterol particles circulating in the blood. For selected patients, a coronary calcium scan may also detect early plaque build-up in the arteries even when other results appear reassuring.
Young adults may not be getting checked
Dr Austin Mohan Komaranchath, HOD and specialist interventional cardiologist at NMC Specialty Hospital, Al Ain, said inadequate screening among younger adults remains a concern.
“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 risk factor that can easily be overlooked. Some younger adults rarely have it checked, while others discover they have elevated readings but do not take the condition seriously.
Dr Austin said some patients are also reluctant to begin blood-pressure medication because they fear they will need to take it for the rest of their lives. That reluctance can leave high blood pressure uncontrolled for years, potentially damaging the arteries.
Similarly, he said patients should not focus only on whether their cholesterol has fallen. What matters is whether it has reached an appropriate target based on their individual cardiovascular risk.
Coronary calcium scoring can provide additional information for selected patients. Dr Austin said that in his practice, around 30 to 40 patients over the past year had abnormal calcium scores despite having reassuring stress tests and echocardiograms.
He explained that stress tests and coronary calcium scans assess different aspects of heart health. A reassuring stress test does not necessarily rule out plaque developing in the coronary arteries.He explained that stress tests and coronary calcium scans assess different aspects of heart health. A reassuring stress test does not necessarily rule out plaque developing in the coronary arteries.
When the heart stops
The seriousness of underlying heart disease becomes especially clear when it results in cardiac arrest.
Dr Mohammed Albialy Sulieman, consultant interventional cardiologist at Medcare Hospital Sharjah, recalled treating a 70-year-old patient whose condition suddenly deteriorated and led to cardiac arrest.
“The prompt attention and CPR procedure at the hospital helped us save the patient’s life, achieving the return of spontaneous circulation,” he said.
Doctors later identified and treated the blockage in the patient’s heart.
“We got the blockage cleared, and he went on to recover well, with his heart function improving steadily at follow-up,” Dr Sulieman said.
Do not ignore the warning signs
Dr Yogeeswari said a heart attack does not always begin with intense or sudden chest pain. Warning signs can vary considerably from one person to another.
Some patients may experience pressure, tightness or heaviness in the chest, while others may develop shortness of breath, sweating, nausea or dizziness. Discomfort can also spread to the arm, shoulder, back, neck or jaw.
These symptoms can sometimes be mistaken for acidity, stress, exhaustion or other less serious conditions, potentially delaying medical attention.
Women may also experience less typical symptoms, including unusual fatigue, weakness, palpitations or dizziness, she said.
Doctors stress that this does not mean everyone in their 30s or 40s needs advanced cardiac testing. Instead, adults should be aware of basic indicators such as their blood pressure, cholesterol and blood sugar levels, know their family history and discuss their individual cardiovascular risk with a doctor.
Regular exercise remains an important part of protecting heart health — but doctors say it should go hand in hand with understanding and monitoring risk factors that may not produce obvious symptoms.
