By Dr. Mayanka Lodha Seth, Chief Pathologist at Redcliffe Labs
Recent incidents of people collapsing during marathons and gym workouts have drawn attention to how cardiac events can sometimes appear sudden. A 31-year-old Bengaluru runner died after collapsing during a marathon, while a 47-year-old doctor in Assam collapsed during a gym workout. Yet, cardiovascular risk can develop silently over months or years, without obvious symptoms. A substantial proportion of heart attacks in India occur at younger ages, with studies reporting that about 25% occur before age 40.
These incidents also highlight why being physically active does not eliminate cardiovascular risk. Regular exercise is protective, but it cannot eliminate risks linked to genetics, blood pressure, cholesterol, diabetes or underlying cardiovascular conditions. In some cases, intense exercise may bring an underlying condition to attention, rather than being the underlying cause of the event itself.
Looking Beyond Routine Checks
A routine health check may include blood pressure, blood glucose, cholesterol and blood tests such as CBC, Lipid Profile, KFT, LFT and HbA1c. These remain important but may not capture every aspect of an individual’s cardiovascular risk. In one study involving 4,975 Indian patients experiencing a first heart attack, nearly 80% had not previously been classified as high risk.
While lipid profiles and blood pressure checks are common in routine health assessments, tests such as Lipoprotein(a), Apolipoprotein B (ApoB) and ambulatory blood pressure monitoring are not routinely recommended for every healthy adult. Their use generally depends on an individual’s cardiovascular risk, family history, symptoms and other clinical findings. Risk-based screening can add value, as ApoB provides information about the number of atherogenic lipoprotein particles, while Lp(a) is a largely inherited risk factor associated with cardiovascular disease. The Cardiological Society of India recommends measuring Lp(a) at least once in adulthood.
Other tests can add context when an individual’s cardiovascular risk remains uncertain or when clinical findings warrant further evaluation. High-sensitivity C-reactive protein (hs-CRP) may provide additional information about cardiovascular risk in selected individuals, while repeated or ambulatory blood pressure measurements can reveal patterns that may be missed by a single reading.
Blood tests such as hs-CRP, hs-Troponin I and NT-proBNP can provide additional clinical information when indicated. hs-CRP can provide information about inflammation, while hs-Troponin I and NT-proBNP have more specific clinical uses, including assessing heart-muscle injury or cardiac strain. These are targeted assessments and are not appropriate or necessary for everyone.
Prevention Does Not Stop with Screening
Finding a risk marker is only one part of prevention. Appropriate follow-up and risk management are equally important. For people already diagnosed with hypertension, dyslipidaemia, or cardiovascular disease, taking prescribed treatment consistently is an important part of managing that risk.
For people taking statins, antihypertensives or anticoagulants, inconsistent dosing can reduce treatment effectiveness or increase health risks, depending on the medicine and the condition being treated. Skipping prescribed medicines, changing doses independently or stopping treatment because symptoms have improved can undermine disease control.
The 2026 ACC/AHA guideline on dyslipidaemia highlights the importance of monitoring both treatment response and adherence to lipid-lowering therapy. It recommends checking lipid levels 4 to 12 weeks after starting or adjusting lipid-lowering therapy, followed by periodic monitoring to assess treatment response and adherence.
The same attention should be given to supplements and over-the-counter medicines. Patients may not always mention these during consultations, but some supplements or over-the-counter medicines can interact with prescribed medicines or affect bleeding risk. Sharing a complete list of prescription medicines, over-the-counter medicines, supplements and other products with a doctor can help identify potential interactions early.
Before Pushing Harder at the Gym
For someone beginning intense training, particularly after a prolonged period of inactivity or with a family history of premature heart disease, the first step should be understanding individual risk rather than assuming fitness alone offers complete protection.
A basic evaluation may include blood pressure, CBC, lipid profile, KFT, LFT and blood glucose or HbA1c testing. Further testing can be considered based on symptoms, medical history, family history and initial clinical findings.
The message is simple. A cardiac event may appear sudden, but the underlying risk may have developed over years. The opportunity lies in looking earlier, identifying risk earlier, understanding individual risk and taking appropriate preventive action before a cardiovascular event occurs. Heart health should move from reacting to collapses to identifying the risks that may have been quietly building long before them.
The article is written by Dr. Mayanka Lodha Seth, Chief Pathologist at Redcliffe Labs.
