Fit On The Outside, But Is The Heart Healthy? Attack Heart Disease Before It Attacks You, Says Cardiologists

Heart disease can begin damaging the body long before chest pain, breathlessness or other warning signs appear. With diabetes, obesity and high blood pressure increasing cardiovascular risks, experts are calling for a stronger focus on early detection using advanced cardiac imaging to identify subtle changes in the heart before they progress to serious complications.

Recent deaths involving seemingly fit people have brought this concern into sharp focus. Just recently, in August 2026, a 31-year-old Bengaluru software professional, Aman Deep Singh Jagade, died after a suspected cardiac arrest while running a half-marathon at Nandi Hills. The same month, a 47-year-old doctor in Assam reportedly collapsed while working out at a gym and could not be revived. These are just a few cases that have come to the limelight, raising questions about how underlying heart conditions can remain undetected even in people who appear physically fit.

"Such cases underline an important point: being physically fit does not necessarily mean the heart is healthy. Some heart conditions can remain silent until a serious event occurs, although not every sudden cardiac death has the same underlying cause," said Dr Rakesh Gupta, Executive Organising President, Indian Academy of Echocardiography (IAE).

This calls for "attacking the illness before the illness attacks", added the Director and Chief Cardiologist of Echo & Colour Doppler Centre, JROP Institute of Echocardiography & Vascular Ultrasound.

"When it comes to heart disease, waiting for symptoms is not always the right approach. Advanced imaging can help us identify changes in the structure and functioning of the heart at an early stage," he said on the sidelines of the recently concluded ECHO-ASIA/ECHO-INDIA 2026 conference.

The four-day event, organised by the IAE and the Asia-Pacific Association of Echocardiography in Gurugram from October 8, witnessed around 1,500 delegates, including doctors and researchers from around 20 countries, such as the UK and Japan, discussing advances in cardiac imaging and their potential to improve diagnosis and patient care.

Dr Hansa Gupta, Senior Cardiologist and President of the Indian Academy of Echocardiography, highlighted the role of echocardiography and strain imaging in understanding early changes in cardiac function. She also talked about how those with diabetes or pre-diabetes should keep a check on their heart health.

"Diabetes can affect not only the arteries supplying blood to the heart but also the heart muscle itself. These changes may develop gradually, sometimes without noticeable symptoms, and can eventually affect the heart's ability to pump blood effectively. Imaging can pick up subtle changes," she said, explaining that echocardiography, commonly known as an echo, uses ultrasound to produce images of the heart and assess its chambers, valves and pumping function.

More advanced techniques, such as global longitudinal strain (GLS), can help identify subtle abnormalities in the movement of the heart muscle that may not be apparent through conventional measurements alone.

Experts said these techniques could help doctors assess selected patients with diabetes, hypertension and other risk factors before symptoms become prominent.

However, advanced imaging is not necessary for everyone. The doctors recommend investigations based on a person's symptoms, medical history, examination findings and overall cardiovascular risk.

When asked about the difference between an ECG, which is commonly recommended by cardiologists, and an echocardiogram, she said the two provide different but complementary information about heart health.

An ECG records the electrical activity of the heart and can help identify abnormal rhythms and electrical changes associated with certain cardiac conditions. An echo, on the other hand, shows the heart's structure and movement, helping doctors assess its pumping function, valves and other abnormalities.

While these tests can help investigate suspected heart disease, neither should be viewed as a substitute for a comprehensive clinical assessment. The choice of test depends on the symptoms and the condition being investigated.

As artificial intelligence (AI) is emerging as another tool in cardiac imaging, Dr S K Parashar, International Chairman, Indian Academy of Echocardiography, said the high-tech concept can support image analysis, take important measurements and identify certain abnormal findings.

Such assistance may help doctors analyse cardiac images more efficiently, but the findings must still be interpreted in the context of the patient's clinical condition.

Dr Manish Bansal, Vice-Chairman of Clinical & Preventive Cardiology at Medanta—The Medicity in Gurugram, stressed that advanced diagnostic tools cannot replace preventive measures. However, diabetes, high blood pressure, obesity, unhealthy diets, hypothyroidism, sleep apnoea, physical inactivity and smoking can increase cardiovascular risk.

Chronic stress, inadequate sleep and air pollution may add to the burden.

Hence, cardiovascular risk assessment should begin early rather than waiting for symptoms to develop. Checks for blood pressure, cholesterol and other risk factors can help identify people who may need lifestyle changes, closer monitoring or preventive medication.

"People with diabetes, smokers and those with a family history of premature heart disease may require particular attention, depending on their overall risk."

Dr JL Meghwal, a general physician from Dr JL Hospital in Ajmer, Rajasthan, said that at times heart disease is not related to the heart itself but is associated with underlying health conditions such as diabetes and hypertension, which can be detected through imaging. But prevention, such as walking, eating healthy and regular health monitoring, remains the best strategy to keep lifestyle-related diseases at bay.

The experts at the conference also cautioned against relying on exercise alone to control high blood sugar while neglecting diet, weight management or prescribed treatment. Medication should be taken as advised, and any changes should be made only in consultation with a doctor.

Dr Manish Bansal was of the opinion that although awareness about preventive health checks has improved, many people stop at getting annual blood tests and fail to act on abnormal results, particularly elevated blood sugar and cholesterol levels.

"Some people also rely exclusively on exercise to control high blood sugar without making the necessary dietary changes or seeking medical advice."

Dr Hansa Gupta also flagged chronic stress, demanding work schedules and pressure to meet financial and social expectations as concerns for cardiovascular health, particularly among younger adults.

"Maintaining a sustainable work-life balance, getting adequate rest and managing stress should therefore form part of a broader strategy to protect heart health."

Dr Bansal recommended assessing cardiovascular risk from a young age, including during the college years, rather than waiting for symptoms to develop. Initial checks should include blood pressure, cholesterol levels and an assessment of other risk factors.

Elevated low-density lipoprotein (LDL), commonly known as bad cholesterol, contributes to the build-up of fatty deposits in arteries. Over time, these deposits can narrow the arteries and increase the risk of a heart attack, he added.

Dr Munesh Tomar, a senior paediatric cardiologist at Meerut-based Lala Lajpat Rai Memorial Medical College, talked about cardiac health in children and pointed out that a range of heart diseases affect children, from congenital heart defects to acquired conditions such as myocarditis, which is most often triggered by viral infections.

"Some need early interventions, while in some treatment takes a long time. But timely detection and treatment is very important in each case," she added.

For children with congenital heart disease, imaging plays a vital role throughout their lives. Repeated scans help doctors monitor the heart as the child grows, track changes and guide timely treatment decisions, Dr Tomar added.