A 44-year-old man arrived at hospital with crushing chest pain at his workplace. By the time he reached the catheterisation laboratory, he was having a massive heart attack. He survived because help arrived in time and because an interventional cardiologist was ready to act. That patient's story captures what Interventional Cardiologist Dr. Pinakin V. Parekh sees regularly in his practice.
Cardiovascular disease, a condition that used to arrive in old age is now arriving at the doors of people in their 30s, 40s, and 50s. This article covers why, what to watch for, and what you can do about it.
Coronary artery disease develops when fatty deposits (plaque) build up inside the coronary arteries that supply the heart muscle. Over years, plaques narrow the artery and reduce blood flow. A plaque that ruptures suddenly can trigger a complete blockage — a heart attack — within minutes.
“Patients are getting younger and younger,” Dr. Pinakin notes. Coronary artery disease is no longer profiled to just be in the 60s, 70s, and 80s. It's no longer just an old person's disease.”
The shift toward younger patients is largely driven by lifestyle changes that accumulate silently over decades:
Those aged 40 and above are recommended to start going for heart health screenings to get a baseline of their heart health. If you have a family history of heart attack or strokes in a close family member, you may want to consider going for one earlier.
Before menopause, oestrogen suppresses LDL cholesterol, raises HDL cholesterol, maintains arterial flexibility, and exerts anti-inflammatory effects on blood vessel walls. After menopause, these protections are withdrawn rapidly. LDL rises, HDL falls, and blood pressure tends to increase — a cardiovascular risk profile that can shift substantially within two to three years of the final menstrual period.
“Once a female patient has menopause, her cardiovascular risk profile changes a lot. The drop in oestrogen hormones — oestrogen hormones are protective — will increase your cardiovascular risk profile,” Dr. Pinakin notes. “If you've never had time to check your health before, once you've reached menopause, that's a good time to take stock.”
Women who have dismissed cardiac symptoms as menopausal (fatigue, breathlessness, palpitations, atypical chest sensations) may in fact be experiencing early cardiovascular disease. A cardiology assessment at or after menopause is warranted, particularly in women with additional risk factors such as a family history, diabetes, or prior gestational hypertension.
Cardiovascular symptoms are frequently misattributed — to stress, indigestion, musculoskeletal pain, or fatigue. The consequences of that misattribution can be fatal.
“Never belittle your symptoms,” Dr. Pinakin stresses. “One of the most painful things for me to see is: you've had symptoms going on for a few days, you've not had time to address it, and it then comes to a stage where it can be too late.”
Not every heart attack presents with dramatic chest pain. Dr. Parekh describes patients who came in with what appeared to be a stomach problem, they initially dismissed it as a gastric problem but it turned out to be an early indicator of an impending heart attack.
Symptoms that may indicate cardiac disease despite appearing unrelated to the heart:
If any of these occur alongside physical exertion or appear suddenly without another clear cause, they warrant cardiac assessment — not a wait-and-see approach.
The diagnostic pathway for cardiovascular disease has advanced significantly. The tests available now allow cardiologists to detect blockages non-invasively, and to characterise their severity with precision before deciding whether intervention is needed.
“One of the most important tests in current generation of cardiology is the usage of CT scans to look for blockages from outside the body, it's called a CT coronary angiogram, and it's frequently paired with a CT calcium score,” Dr. Pinakin explains. “When you detect a blockage on a CT scan, a doctor will need to delineate how bad the blockages are — and if significant enough, we bring you to the lab to do an angiogram.”
A CT coronary angiography (CTCA) acquires hundreds of images in seconds during a single breath-hold, reconstructed into a detailed 3D map of the coronary arteries. It identifies atherosclerotic plaque — including soft plaque that does not yet calcify — and quantifies luminal narrowing. CT calcium scoring measures the amount of calcified plaque present, stratifying long-term cardiovascular risk even in asymptomatic patients.
For borderline blockages identified on CT or at conventional angiogram, Dr. Parekh uses additional intravascular tools — pressure measurement (FFR) and intravascular imaging (IVUS, OCT) — to assess whether a stent is truly warranted, minimising unnecessary intervention while ensuring no significant blockage is left untreated.
Treatment for coronary artery disease is matched to severity. Not all blockages require stenting, and the goal of treatment is to relieve ischaemia (inadequate blood supply to the heart muscle) and reduce the risk of future events.
Cardiovascular disease kills and disables at scale not because it cannot be treated, but because it is too often found too late.
Dr. Pinakin stresses the importance to always get an opinion from a doctor if you are feeling unwell, “I know it takes effort to see a doctor — it disrupts your schedule. But it is always very useful, take it from me, to always get an opinion from a doctor just to make sure you are safe and heading in the right direction. I cannot belittle this point. This is the same advice I've been giving patients over and over again for a long time.”
The risk factors of cardiovascular diseases are silent, the symptoms are easy to dismiss, and the diagnostic tools to find disease early are widely available but underused. A blood test, a blood pressure check, an ECG, and a CT scan are not difficult to arrange — they are the difference between catching a problem and managing it, or meeting it in an emergency.
