Should young adults worry about heart disease?

Published on 19 October 2026

Dr Nicholas Chew from the National University Heart Centre, Singapore, explains why heart disease can develop silently in younger adults, including those who appear fit and healthy.

At a glance

• Heart disease can develop silently in adults in their 30s and 40s, including those who appear fit and healthy.
• Borderline risk factors can add up over time, increasing a person’s risk even when no single measurement appears especially concerning.
• Regular screening, consistent exercise and a balanced diet can help younger adults identify and manage their risks early.

A heart attack may be the last thing someone in their 30s or 40s expects, particularly if they feel well, stay active and are busy building a career or raising a family.

Yet Dr Nicholas Chew, a Consultant in the Department of Cardiology at the National University Heart Centre, Singapore (NUHCS), is seeing coronary artery disease affect younger adults more frequently. What is more alarming is that in some cases, the condition becomes apparent only when they suffer their first heart attack.

“We are increasingly seeing heart disease in patients who would once have been considered too young to be at risk,” said Dr Chew, whose clinical and research interests include coronary artery disease among younger patients.

“Some of these patients are young professionals building their careers and raising families. They may look healthy and feel well, making a diagnosis of heart disease particularly unexpected.”

Long working hours, insufficient sleep, prolonged stress, easy access to calorie-dense food and a lack of regular physical activity can all gradually affect heart health. These factors also tend to reinforce one another, as someone experiencing sustained stress may sleep poorly, exercise less and snack more frequently.

“It doesn’t just happen in isolation,” Dr Chew explained. “All the risk factors accumulate together over time and lead to heart disease.”

When borderline risks add up

The major risk factors for coronary artery disease include diabetes, high blood pressure, high cholesterol, and smoking. However, a person’s risk is not always clear-cut.

A younger adult may have slightly raised blood pressure, borderline cholesterol, excess abdominal fat, and a sedentary lifestyle without any individual measurement being high enough to cause immediate concern. Taken together and sustained over time, however, these factors may place the person at greater risk than they realise.

There are also people who experience heart attacks despite appearing healthy. Dr Chew said data have shown that about one in 10 patients who experience a heart attack may not have conventional risk factors such as diabetes, high blood pressure or high cholesterol, and may not smoke.

Meanwhile, some may exercise regularly but have other, less apparent risks, including a strong family history of heart disease. This is why younger adults should not rely solely on how fit or healthy they appear.

Consistency matters more than intensity

While exercise is an important part of protecting the heart, squeezing an entire week’s worth of activity into one strenuous weekend session may not be the best approach, said Dr Chew.

Indeed, someone who remains seated at a desk throughout the working week before pushing themselves through an intense spin class or football match at the weekend is placing a sudden demand on a body that has not been active regularly, increasing the strain on their heart and their risk of injury.

“The bottom line is that consistency is more important than intensity when it comes to exercise,” Dr Chew said. “I recommend aiming for about 150 minutes of moderate physical activity each week. This could be divided into 30-minute sessions on five days and may include activities such as brisk walking, jogging or resistance training.”

Diet also matters, with Dr Chew advising people to look beyond whether a food is marketed as healthy and pay attention to its overall sugar and calorie content.

“Foods commonly perceived as healthy may still contain large amounts of sugar or calories once toppings and sauces are added,” he said. “So, it’s important to be mindful of your portions and eat in moderation.”

Know your heart-health numbers

Heart-health screening begins with several basic measurements, including blood pressure, cholesterol, blood sugar and waist circumference. A person’s smoking status and family history should also be considered.

A blood pressure monitor can be useful for the household, while a measuring tape can help people keep track of their waist circumference. Unlike body mass index, which considers weight in relation to height, waist circumference gives an indication of the fat stored around the abdomen and internal organs.

To take the measurement, place a measuring tape around the waist at the level of the belly button. A waist circumference above 90cm for men or 80cm for women may indicate excess abdominal fat.

Adults in their 30s should consider speaking to a general practitioner about screening if they have symptoms, borderline risk factors or a strong family history of heart disease. From the age of 40, eligible Singapore residents can also undergo recommended health screenings through Healthier SG.

Dr Chew, however, warned that these results should not be viewed independently. Instead, he encourages individuals to discuss their overall risk profile with a doctor, who can assess how the different factors interact and advise whether lifestyle changes, closer monitoring or treatment may be needed.

Heart disease can remain silent

One challenge in detecting coronary artery disease is that symptoms may not appear during its early stages.

Likening the coronary arteries to water pipes, Dr Chew explained that deposits can gradually collect within a pipe while water continues to flow normally. Similarly, cholesterol-containing plaque can accumulate within the arteries while blood continues to reach the heart.

As the disease progresses and blood flow becomes restricted, a person may experience chest discomfort or breathlessness during physical activity. However, some people unintentionally conceal these warning signs by reducing their activity.

“I have patients who say they used to experience chest discomfort while running, but the symptoms are now completely gone,” Dr Chew said. “When I ask why, they tell me it is because they stopped running.”

While avoiding exertion may prevent the discomfort from recurring, it does not address the underlying blockage. In some cases, plaque can rupture and trigger a blood clot, leading to a heart attack within minutes.

Chest discomfort related to the heart commonly occurs in the centre of the chest, is brought on by exercise or intense emotion, and improves with rest. A noticeable decline in exercise capacity, such as becoming unable to climb stairs or run as comfortably as before, may also warrant medical attention.

However, symptoms do not always follow a typical pattern. Anyone concerned about chest discomfort or unexplained breathlessness should seek medical advice rather than attempting to diagnose the cause themselves.

For most people, the first step remains regular screening and a conversation with their doctor.

“Start early with prevention and make sure you know your numbers,” Dr Chew said. “The most important thing is to go for your health screening.”

In consultation with Dr Nicholas Chew, Consultant, Department of Cardiology, NUHCS.