Think you’re healthy and safe from a heart attack? Doctors warn hidden risk factors may be putting you at risk: Here’s what to watch for

There is an assumption that shows up in everyday conversations: eat clean, stay active, and the heart will follow. It sounds reassuring, but it is not always true.

Some of the most alarming cardiac events happen in people who look fit, maintain a steady routine, and rarely fall sick. The gap lies in what “healthy” usually measures and what it misses.

Dr Samanjoy Mukherjee, HOD & Consultant - Interventional Cardiology, Manipal Hospitals Dwarka, New Delhi, explains, “Most of us think that if we do a little bit of exercise and just eat right, we are automatically safe from a heart attack. While those habits are great and should be followed, they don't tell the whole story.”

Fitness is visible. Heart risk is not. A stable weight, clear skin, and good stamina can create a sense of control. But deeper processes such as inflammation, arterial damage, and hormonal imbalance do not show up in the mirror.

“Many people who appear to be in perfect shape still face serious heart risks,” Dr Mukherjee explains. “This happens because being healthy from above usually only covers the basics like weight, but it often ignores deeper issues like genetics, internal inflammation, and hidden stress.”

This mismatch matters because heart disease builds quietly. According to the Indian Council of Medical Research, over 50% of cardiovascular diseases occur in people under 70.

Stress rarely looks dramatic. It hides in deadlines, poor sleep, and constant mental noise. Over time, it pushes the body into a state of alert, raising blood pressure and inflammation.

“Stress, anxiety, and emotional health are also factors that may affect heart health,” says Dr Mukherjee. “Lack of sleep, high mental pressure and emotional stress are often not given due consideration but may have serious consequences on heart health.”

A report by the World Health Organization links chronic stress to increased risk of hypertension and cardiac events.

Some risks are written long before lifestyle choices begin. A family history of early heart disease can double the chances of similar outcomes, even in otherwise disciplined individuals.

“Your genetic makeup and family history are also important factors,” Dr Mukherjee notes. “Many people do not consider this factor because they think they are healthy, but nowadays we can see that heart disease may occur at an early age.”

This is why two people with identical habits may have very different outcomes. One stays protected, the other faces sudden complications.

High blood pressure, cholesterol, and diabetes do not always cause obvious symptoms. They build slowly and damage arteries over time.

“High blood pressure, high cholesterol levels, diabetes, etc., are the silent killers of the heart,” Dr Mukherjee says. “These may cause heart attacks without the presence of serious health problems.”

A study published in the NIH shows that a large portion of Indians with hypertension are unaware of their condition.

Regular screening becomes the only reliable way to catch these risks early.

Sleep is often treated as optional, especially among busy professionals. But the heart reads every lost hour.

“When we talk about heart health, sleep plays a critical role and should not be neglected,” says Dr Mukherjee. “Inadequate or poor-quality sleep can disrupt heart rhythms, increase stress levels, and contribute to metabolic disorders.”

Lifestyle also goes beyond workouts. Smoking, alcohol, erratic meals, and even excessive training without recovery can cancel out the benefits of exercise.

Being active does not always mean being protected.

Prevention today looks different from what it did a decade ago. It is less about appearances and more about awareness.

“Regular health screenings, such as blood pressure monitoring, cholesterol levels, blood sugar tests, ECG, and cardiac risk assessments, can help prevent heart problems from occurring,” Dr Mukherjee advises.

He adds, “If risk factors and symptoms are recognised at an early stage, various treatment options are available…. The key to heart health is, therefore, to stay one step ahead by being proactive.”

That means listening to the body even when nothing seems wrong, and checking what cannot be seen.

Good habits are powerful, but they are not a guarantee. Health is layered, and the heart often works in silence until it cannot.

Medical experts consulted
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This article includes expert inputs shared with TOI Health by:

Dr Samanjoy Mukherjee, HOD & Consultant - Interventional Cardiology, Manipal Hospitals Dwarka, New Delhi.

Inputs were used to explain why appearing ‘healthy’ does not always safeguard against a heart attack, highlighting the overlooked risk factors and the importance of medical evaluation even in individuals without obvious health issues.