Why Indians face higher heart risk

Heart disease is no longer a problem of old age or rich countries. In India, it starts early and grows silently. Doctors now see heart attacks in people in their 30s and 40s. Many look “normal” from the outside. But inside, risk builds up for years. This is why Indians face a higher heart risk, and why understanding the reasons matters more than fear.Research from the Journal of Clinical and Diagnostic Research shows that Indians tend to develop heart disease at a younger age than many other populations. One reason is body composition. Indians have higher body fat even at a lower weight. This fat settles around the belly and organs, not just under the skin. Doctors call this “thin-fat” Indian body type. This hidden fat raises blood sugar, cholesterol, and inflammation together. That mix is dangerous for the heart. Heart disease in India does not start with chest pain. It starts with insulin resistance, fatty liver, and rising triglycerides. These changes appear in the 20s.The ICMR-INDIAB study, a large government-backed study, showed high levels of diabetes and prediabetes across urban and rural India. Diabetes is one of the strongest drivers of heart disease. When sugar stays high for years, arteries stiffen quietly. By the time symptoms appear, damage is often advanced.Dr Rohit Goel, Principal Consultant - Cardiology, Max Hospital, Gurugram, said, "Heart disease is more common in Indians than in most other nationalities and tends to occur anywhere from 5-10 years earlier due to certain factors like genes, body fat, insulin resistance, diabetes and cholesterol levels, that are uniquely Indian." Traditional Indian diets were simple, seasonal, and fibre-rich. Today’s plates look very different. Refined grains, sugar, fried snacks, and packaged foods dominate daily meals.The problem is not the celebration food. The problem is everyday food behaving like festival food.Government data from the National Family Health Survey-5 (NFHS-5) shows rising obesity and metabolic risk across states. Too much refined food raises bad cholesterol and lowers good cholesterol at the same time. That double hit harms arteries.Dr Goel added, "Furthermore, many additional lifestyle and environmental factors increase the risk of heart disease, including sedentary living, stress, using tobacco, eating poorly, and being increasingly overweight or obese. It is important to undergo screening at an early age; exercise regularly; maintain a healthy weight; and control your blood pressure and diabetes to reduce your risk of developing heart disease." Indian lifestyles changed faster than Indian biology. Long work hours, traffic, financial pressure, and poor sleep are now common. Stress hormones stay high for years.Chronic stress raises blood pressure and triggers inflammation inside blood vessels. It is said that stress is the silent killer of human potential. The same silence applies to the heart. Stress alone may not cause heart disease, but combined with poor diet and low activity, it speeds things up.Earlier generations walked more without planning to. Work, markets, and social life involved movement. Today, even children sit for long hours. Lack of movement weakens the heart muscle and worsens cholesterol balance. The body was designed to move often, not occasionally.While smoking rates have declined in some groups, new forms like smokeless tobacco and vaping are rising. Alcohol intake has also increased, especially among younger adults. Even small, regular exposure damages blood vessels and raises clot risk.Genetics play a bigger role in Indian heart disease. If parents had heart problems early, risk multiplies. Genes affect how Indians handle fats and sugars.This does not mean fate is fixed. It means prevention must start earlier. Screening in the 20s and 30s can change outcomes quite dramatically. Heart advice copied from Western countries does not always fit Indian realities. Smaller waist targets, earlier screening, and diet advice rooted in Indian kitchens work better.Simple steps matter:As Mahatma Gandhi said, “It is health that is real wealth.” For Indian hearts, this line is deeply literal.Medical experts consultedThis article includes expert inputs shared with TOI Health by:Dr Rohit Goel, Principal Consultant - Cardiology, Max Hospital, GurugramInputs were used to explain why Indians have a higher risk of heart disease and why early screening and preventive care are especially important.