Fit is not equal to healthy: Why physically elite die of sudden heart attacks

Being lean, muscular and active are no longer the best parameters to judge one's health. Even the most-healthy looking people, including actors and athletes are falling prey to sudden heart attacks. Doctors warn that sudden heart attacks often feed off high cholesterol, poor sleep and fancy diets and explain how the definition of healthy has changed in the recent time.

A perfectly fit and fine person who is going about their routine day dies of a sudden heart attack. No warnings and no ultimatum, but a tragic end. This is no longer mere fiction but glooming reality.

Being lean, fit and muscular are no longer the best indicators of good health. Why, you ask? Because a perfectly healthy person may be a hot oven, marinating several diseases inside their body, including cardiovascular ones.

Take for example, the recent case of Days of Our Lives star Patrick Muldoon. The 57-year-old otherwise healthy actor, who was super active on Instagram, a couple of days before his death, died suddenly on April 19.

Another case in point is 30-year-old Haryanvi actor Divyanka Sirohi who, too, died of a sudden heart attack, just two days after Muldoon's death, on April 21.

And these are not one-off instances, Reema Lagoo, Shefali Jariwala and Sidharth Shukla, all met the same doomed fate — with their cause of deaths revealed to be sudden heart attacks.

Several cricketers, too, who are believed to be the most healthy among others, have suffered heart attacks in the past few years.

With the rise in such unfortunate cases, the glaring question is why healthy or fit-looking people die of heart attack and cardiac arrests? Are there any warning signs that were missed? Or did death grip them silently?

The most basic explanation is that high LDL leads to plaque buildup that narrows arteries and increases the risk of heart attacks and strokes, even if you are meeting your daily goal of 10,000 steps.

As per a recent report titled "India's Silent Health Crisis: A Full National Risk Assessment (2023–2025)" by ekincare, 31.7% have abnormal cholesterol levels, signalling increased cardiovascular risk. According to the report, Haryana (34.9%) and Karnataka (33.7%) have recorded the highest cholesterol and cardiovascular risk levels.

Dr Rajendra Chavan, MBBS MD DM Cardiology, Apollo Clinic, Nigdi, tells you that heart attack or stroke can happen to anyone, including people who seem healthy.

"Heart disease can be silent, meaning it may not give you any indication you should see your doctor," Dr Chavan said.

Dr Chirag D, Consultant - Interventional Cardiology, Aster Whitefield Hospitals, said that, as opposed to the common belief, even someone who appears lean, exercises regularly, and have no obvious symptoms, can still carry underlying structural or electrical abnormalities of the heart.

"This is possible, and it is one of the most misunderstood aspects of heart health today. Our work as cardiologists establishes that physical fitness assessments do not provide accurate measurements of a person's internal vascular system condition. Conditions such as hypertrophic cardiomyopathy or inherited rhythm disorders can remain silent for years and may only present during a sudden cardiac event," Dr Chirag explained.

He added that most of these medical situations do not involve standard heart attacks which result from arterial blockages because they lead to immediate cardiac arrests which stem from heart electrical system disruptions.

Dr Chirag pointed out that there's a reason why healthy people experience dangerous heart problems without any warning signs.

"A recent research published in 2025 studying athletes found that microscopic abnormalities in heart tissue were present in a significant proportion of individuals who had normal routine tests, suggesting that conventional screening may miss subtle but clinically important risks," Dr Chirag added.

Complex signs

Some of the hidden causes of heart attacks in otherwise healthy people, Dr Chirag said, are complex.

"In individuals who appear healthy, the causes are often less visible and more complex. Genetic and inherited conditions are among the most important contributors, including disorders that affect the structure of the heart muscle or its electrical system. These conditions may not produce symptoms until they are triggered by exertion, stress, or illness," he said.

Also, low-grade inflammation and past viral infections like myocarditis create symptoms that damage heart function without showing any visible indicators.

"The present-day way of living has a major impact on health. Many people combine long hours of sedentary work with intermittent high-intensity exercise which can trigger problems when people have hidden health issues," Dr Chirag opined.

What not to miss

Dr Pradeep Haranahalli, Consultant – Interventional Cardiology, Manipal Hospital Whitefield, said that the age-old saying goes sound mind and sound body. However, the current cardiac health scenario compels us not to say sound heart and sound body.

The real danger lies in the fact that most patients are sensitive to the classical textbook picture of anginal chest pain. However, often they tend to mistake or miss some of the subtle symptoms.

"Unexplained fatigue, dizziness or fainting attacks, or some not-so-classical just pain symptoms, like pain only in the hand, pain in the neck, or back pain. Pain in the jaw may often be mistaken for not being associated with a heart problem," he said.

Another similar circumstance can be where people feel upper abdominal pain as gastric or heartburn, advised to consult a gastroenterologist, or may continue to take antacids for a longer time.

Neglecting to consider such symptoms could be cardiac as well. Some of the other common symptoms that may go ignored are people failing to recognise that they were able to tolerate a certain level of physical activity but now has suddenly become symptomatic with the same level of activity. So these are all some vital clues to escalate the matter for further evaluation," Dr Pradeep advised.

Family history plays a major role

The strongest predictor of cardiac risk assessment, Dr Chirag said, exists in family history.

"A genetic predisposition increases heart disease risk even for people who maintain healthy lifestyles. Family members with cardiomyopathies and inherited arrhythmia syndromes will experience undetected conditions that require specific testing methods for identification," Dr Chirag explained.

Patients who have developed good health habits still present with two common patterns: they have suffered sudden cardiac death or they have experienced early heart disease majorly because of their family history.

"The genetic risk factors in these cases create a lower threshold for stress and intense exercise to trigger an event. Medical professionals need to obtain detailed family history because it helps them decide which screening methods and preventive measures should be applied in patient care," he added.

Can intensive exercise increase risk of sudden heart attacks?

While there have been several instances where young people suffered sudden heart attacks while working out in gyms, Dr Chirag, assured exercise remains the most effective method to decrease long-term cardiovascular disease risk.

"One of the possible reasons why some suffer from heart attacks while working out in gyms is that they were already suffering from hidden heart problems," Dr Chirag clarified.

The other reason, he said, is that the body experiences increased heart strain through sudden high-intensity workouts when performed without proper training, in sickness and in pursuit of exceeding physical limits. Hence, in some instances, this could possibly trigger heart disease by putting sudden and extra strain on the heart.

Men and women are affected by coronary artery disease (heart attack) and cerebrovascular disease (stroke) in different ways. Men generally begin developing cardiovascular disease in their mid-30s, primarily due to differences in the levels of hormones such as testosterone. Women benefit from protective hormone levels until menopause, therefore reducing their risk until then.

Dr Rajendra Chavan, MBBS MD DM Cardiology, Apollo Clinic, Nigdi

Stress and sleep also play a part

Dr Chirag explained that research suggests stress and sleep patterns together with mental health conditions increases cardiovascular disease risk which people frequently overlook.

"If the body maintains elevated stress levels because chronic stress leads to continuous production of stress hormones like adrenaline and cortisol, it results in higher heart rate and blood pressure, thereby increasing the risk of heart rhythm disorders. This condition develops over time to establish a physical state that increases the likelihood of heart-related emergencies," Dr Chirag warned.

Time and again, several studies have revealed that the body needs about eight to nine hours sleep to restore essential functions which include heart health. The body often compensates for poor sleep with hormonal imbalances leading to increased inflammation and blood pressure problems.

"Recent studies have shown that even modest improvements in sleep duration and quality lead to substantial decreases in heart attack and sudden cardiac arrest risk," Dr Chirag said.

Fancy diets might be putting you at risk

Dr Pradeep said that not all diets followed for fitness may be cardio-safe.

"In the fitness lifestyle, some of the supplements, such as a high-protein diet with an extremely low-carb diet, can lead to electrolyte disturbances posing a serious cardiac life threat," Dr Pradeep warned.

People who are into high-intensity workouts may also use stimulant drugs or caffeine, before the workout to enhance performance.

"This can also work as a pro-arrhythmia environment and lead to the risk of cardiac arrest and arrhythmia," Dr Pradeep explained, while adding that use of anabolic steroids and performance-enhancing drugs can also lead to heart muscle weakness and the risk of sudden cardiac death due to arrhythmias.

He pointed out that some stimulant medications are also used for fat burning, which may also create disturbance in the heart rhythm, leading to sudden cardiac issues.

"An individual may look lean, muscular, fit, and disciplined, but he may be harboring elevated apoprotein levels and elevated cholesterol levels by virtue of this," Dr Pradeep opined.

Avoiding extremes of diet, good hydration and maintaining electrolyte balance during workouts are key. One should avoid stimulant drugs, performance enhancers, and other muscle building supplements. Being educated and aware of CPR technique is equally important.

Dr Pradeep Haranahalli, Consultant – Interventional Cardiology, Manipal Hospital Whitefield

Gym-culture and facade of health

Being lean, having low body fat, or displaying visible muscles is frequently equated with overall fitness and longevity. Similarly, the ability to sustain long workout sessions is often perceived as a marker of superior health. However, these indicators reflect only a limited aspect of physical conditioning and should not be extrapolated as comprehensive evidence of good health.

"Visible abs or muscularity do not necessarily translate to cardiovascular fitness, metabolic health, or long-term well-being. Likewise, exercising for extended durations does not automatically confer greater health benefits; in some cases, excessive training without adequate recovery may even be counterproductive," Dr Pradeep explained.

Common misconceptions persist, such as believing that regular workouts alone guarantee fitness, or that the absence of symptoms implies the absence of disease.

"In reality, serious conditions, including underlying cardiovascular issues, can remain silent and undetected. This is why instances of sudden cardiac events are occasionally seen even in individuals who appear outwardly fit and active," Dr Pradeep added.

It is also important to clarify that while exercise is generally beneficial, it can sometimes act as a trigger for adverse events in individuals with pre-existing, undiagnosed conditions. Exercise itself does not cause disease, but it may unmask hidden health risks.

Are regular health check-ups enough?

When it comes to heart, doctors suggest that the answers are much complex.

"These are not enough. Regular health checks often involve protein tests like CBC, checking for cholesterol, sugar, ECG, and an echocardiogram.  However, this may serve as an initial screening tool, but never complete or comprehensive enough to pick every heart problem at its early stage," Dr Pradeep said.

He added that routine health checks can miss early-stage blocks, electrical disturbances, or some scar in the heart muscle due to past myocarditis or many other such scenarios.

"Screening tests cannot be generalised to everyone, and hence any advanced cardiac evaluation should happen under the guidance of a clinician to customise the investigation specific to the patient's risk profile," Dr Pradeep explained. 

Patients may require some additional tests based on their risk profile.

"Lipoprotein A, apolipoprotein B, and apolipoprotein A1, Connecticut coronary calcium scoring, Connecticut coronary angiogram, could be done on top of the routine basic health check, for further clarity on risk assessment," Dr Pradeep concluded.