A 35-year-old woman working in a corporate office in Gurugram had to sit for long hours on her laptop. She also had a ritual of watching a few episodes of her favourite series during her breaks and at night to relieve stress from an all-consuming routine. Several months later, she began experiencing continuous fatigue, shortness of breath and occasional chest tightness. She got a routine check-up done that revealed high cholesterol levels and early signs of heart strain, all linked to prolonged sedentary behaviour and a poor diet.But once she did the calcium score test as suggested, a non-invasive CT scan that measures the amount of calcium deposits in the coronary arteries, she was surprised to know that she had calcified plaque deposits and a greater risk of a heart attack. That’s when she consulted Dr Yugal Kishore Mishra, chairman, Manipal Institute of Cardiac Sciences, New Delhi. She got diagnosed with coronary artery disease (CAD), with multiple critical blocks caused by the buildup of plaque in the inner lining of an artery that could have led to a heart attack. “Had she not got tested, she could not have prevented complications. With early diagnosis and right treatment, she got better,” he says.What are triggers of a blockage?“Long hours of sitting, stress-eating, unhealthy sleep patterns and skipping physical activity can raise the risk of heart problems like coronary artery disease (CAD), blood pressure, elevated cholesterol and obesity. When paired with late-night snacking, these habits can have a negative impact on the cardiovascular system, especially in young adults. Prolonged sitting slows down blood flow, raises blood sugar and low density lipoprotein (LDL) or ‘bad’ cholesterol, and encourages belly fat, all of which strain the heart. Over time, this sedentary habit weakens cardiovascular fitness and increases the risk of heart attacks. That’s why we need to check our heart health from the mid-20s,” says Dr Mishra.Story continues below this adWhy should one begin testing in the 20s? Which ones to do?Given that Indians are more vulnerable to heart disease and manifest symptoms a decade earlier, Dr Karthik Vasudevan, chief of interventional cardiology and heart failure, Manipal Hospital, Bengaluru, recommends a decadal approach to testing.“For those in the 20-30 age group, risk assessment is the most important. That’s why it is important to check blood pressure, cholesterol, blood sugar, body mass index and weight. Should the parameters swing way outside of the normal range or the patient have a family history, then some other detailed tests can be done. Otherwise, blood tests to check risk factors like cholesterol, liver and kidney function and blood glucose are recommended. Cholesterol abnormalities can show up rather early and can be controlled. Electrocardiogram or ECG is needed to check the heart’s electrical activity, its rhythm and overall health. Echocardiogram uses sound waves to create images of the heart’s structure and function. The last two are useful as a baseline,” he says.For the 30 to 45 group, Dr Vasudevan recommends an additional treadmill test (TMT) which evaluates your heart’s ability to handle physical exertion by monitoring your heart rate, blood pressure and electrocardiogram (ECG) as you walk on a treadmill.Story continues below this adHe suggests calcium scoring for those with a strong family history, diabetes or other high-risk factors. “A CT coronary angiogram should be only in select high-risk cases, to visualise blockages,” he says.This is the mid-career, high performer group, chasing unreasonable deadlines. “They have a sleep deficit as they work at odd times to suit American business hours. They have early onset diabetes because of a high-sugar, high-salt diet. They are mostly desk-bound and highly stressed, seeking relaxation through binge drinking, smoking and substance abuse, all of which can pummel the heart,” he says.For those above 50, most of whom are likely to have some form of co-morbidity and are age-wise more predisposed, he suggests additional calcium scoring and a coronary CT. “Just the other day, I had a 50-year-old patient present himself to us with mild hypertension. He had no risk factor, no family history but had a stressful life with irregular sleep and meals. Once his TMT test came as positive, we did an angiogram and found blocks in all three arteries, which we could address in time,” says Dr Vasudevan. An invasive angiogram is to be done only when these tests clearly show blockages or symptoms like chest tightness while walking uphill, he cautions.Do we need a heart CT?Cardiologists at the All-India Institute of Medical Sciences (AIIMS) suggest a preventive approach from the basic level. “Detect hypertension and get it treated (diagnosed by blood pressure above 140/90 mm Hg), treat diabetes (blood report of HbA1c above 6.5 per cent, fasting blood sugar > 126 mg/dl), control obesity (body mass index calculated from height and weight showing a value more than 25 ) and control your raised cholesterol (low density lipoprotein or LDL cholesterol >130, triglycerides >150 ),” says Dr Sandeep Seth, professor of cardiology, AIIMS.Story continues below this adYou should regularly measure your bad (LDL) and good (high density lipoprotein or HDL) cholesterol levels. Aim to keep the ratio of total cholesterol to good cholesterol below 4.5. This is more important for those who have suffered heart or brain attacks, where we aim to keep bad cholesterol below 70-100 mg/dl.A CT angiogram is not required, he says. “When it comes to big vascular structures like arteries, we go by risk factors, which by and large exist in any Indian male above 40 given their genetic predisposition. So that is why we look at controlling all the risk factors from a younger age, be it diabetes, blood pressure, cholesterol, obesity and even Vitamin D deficiency,” he says. Vitamin D is needed for calcium regulation, inflammation and blood pressure control. Low vitamin D can impact calcium levels, thereby affecting heart muscle contraction and triggering irregular heartbeats or arrhythmia.“The other most important factor we consider is family history. If a person has this risk, or has high BP, high cholesterol, smoking and sedentary lifestyle, then we do a CT calcium score for this high risk group. If the calcium score is high, it means a plaque buildup. Then we put the patient on cholesterol-lowering drugs,” says Dr Seth.“If the patient has a family history, then we check the carotid artery, more specifically the carotid intima, which is the innermost layer of the carotid artery, composed of a single layer of endothelial cells. We measure the thickness of this inner layer or intima to assess cardiovascular disease risk. This can be done with a simple ultrasound test, which is not too expensive,” says Dr Seth.Story continues below this adThis ultrasound helps detect early signs of plaque buildup in the carotid arteries and can be an early warning sign of potential heart problems, even before symptoms appear.No predictive test can work without taking care of diet, exercise and sleep hygiene. If your blood markers are on the higher side, go on a high-fibre, high-protein diet complemented with resistance training. Consult a doctor on lifestyle corrections.