He lifted weights, was a regular runner, didn’t smoke or have blood sugar: Why then did he have 100% blocked arteries?  

After we opened up his arteries with stents, he told me that none of his doctors had ever suggested a heart health check-up assuming him to be a healthy person. “Frankly doctor, I had never felt anything was wrong either. I was a non-smoker, didn’t have diabetes, had healthy eating habits and was not given to excesses. The only test I ever did till then was to check for blood sugar, since everybody said diabetes could be a silent killer even in fit individuals. But even that came clean,” he told me.

But he had one problem that timely tests would have shown up: A genetic history of high LDL (low-density lipoprotein) or bad cholesterol. In other words, his cholesterol formed faster than normal individuals and piled up as plaque constricting the heart’s arteries.

What does a family history of cholesterol mean?

The most significant factor for rapid, high-volume cholesterol production is what we call familial hypercholesterolemia. This is an inherited genetic disorder where the liver is unable to effectively remove LDL cholesterol from the blood. So, the liver receptors that clear it are missing or not working properly in the affected person, compared to others. Consequently, excess LDL floats around in the bloodstream and deposits itself in the arteries. Such people not only have high cholesterol from their early life, they also tend to have unstable plaques, putting them at a much higher risk for heart attacks at a young age. Even a partial blockage can cause a 100% blockage if the plaque ruptures easily, causing a blood clot to form rapidly.

A genetic predisposition, particularly if a close relative (parent, sibling) developed heart disease at an early age (before 55 for men, 65 for women), increases risk.

How genetic history becomes a bigger risk with other triggers

My patient was aggressive with his weight lifting. Sudden jolts and movements without adequate rest or overdoing weights can trigger a heart attack or acute event in people with pre-existing, often undiagnosed, artery blockages.

Heavy, intense lifting can induce extreme, temporary blood pressure spikes (sometimes over 250/170 mmHg), which can cause plaque rupture, tearing and clotting in already narrowed arteries, leading to a sudden heart attack, including in the LAD artery.

What are other triggers?

Watch out for chronic high blood pressure as that damages the inner lining of the coronary arteries, making them more susceptible to plaque buildup and narrowing. High blood sugar damages blood vessels and nerves that control the heart, significantly accelerating plaque buildup. Long-term kidney issues are linked to increased risk of coronary artery disease.

Conditions like rheumatoid arthritis and lupus can cause inflammation that damages arteries. Diets high in saturated fats, trans fats, salt and refined sugars promote plaque buildup. As do a sedentary lifestyle, obesity and chronic stress. In some cases, the LAD itself may be too narrow to handle even milder plaques.

Of course, there is an easy way to avoid such a crisis. Everybody should just get a lipid profile test done from age 21; it’s a good way to track a genetic pattern.

(Dr Shetty is lead cardiologist and medical director, Sparsh Hospital, Bengaluru)