Feeling fine is not the same as being fine.
Across India, an estimated 150 million people carry a silent narrowing in their arteries — no pain, no warning, no awareness. A cardiologist at Ramaiah Memorial Hospital is urging the public to understand that atherosclerosis is not fate written in genes, but a slow accumulation of daily choices and unattended conditions. In a nation where one in eleven adults is already affected, the most dangerous myth may be the belief that the body will announce its own emergency before it is too late.
- The disease moves without announcing itself — by the time chest pain or breathlessness appears, dangerous arterial narrowing may already be well advanced.
- A fog of misconception is making the crisis harder to contain: diabetics assume medication covers their heart risk, leg cramps get dismissed as aging, and cholesterol drugs are treated as a license to eat poorly.
- Each myth dismantled by Dr. Prakash points to the same gap — people are waiting for symptoms in a disease that specializes in silence.
- The path forward runs through routine screening, honest lifestyle accounting, and the recognition that statins and blood sugar medication are floors, not ceilings, of protection.
- With 150 million Indians already living with cardiovascular disease in 2025, the window for interrupting this epidemic through early action is open — but it will not stay that way.
Somewhere in India right now, a person is going about their day with no idea their arteries are quietly narrowing. No chest pain, no shortness of breath — just the slow, invisible accumulation of plaque inside arterial walls that defines atherosclerosis. It is this silence, more than anything else, that Dr. V S Prakash of the Ramaiah Institute of Cardiac Sciences wants people to reckon with.
The scale of the problem is difficult to absorb: an estimated 150 million Indians were living with cardiovascular disease or clogged arteries in 2025, roughly 11 percent of the adult population. Atherosclerosis develops when the arterial lining is repeatedly damaged by inflammation, high blood pressure, elevated cholesterol, blood sugar, and smoking. The body patches each wound with fatty deposits that harden into plaque, narrowing the artery until blood flow becomes labored — and, eventually, until a heart attack or stroke occurs.
Dr. Prakash identifies several misconceptions that are quietly worsening this burden. The first is the assumption that symptoms will serve as a reliable warning system. They often won't. Significant blockages and dangerously elevated cholesterol can exist without any felt signal, which makes routine blood pressure monitoring and cholesterol testing not optional extras but essential tools.
Diabetes medication is another source of false reassurance. Controlling blood sugar through prescription drugs reduces risk but does not eliminate it — high glucose continues to damage blood vessels and accelerate plaque formation regardless of medication compliance. Diet, exercise, and stress management must accompany any pharmaceutical regimen. Similarly, cholesterol-lowering statins do not neutralize the damage done by excess sugar, saturated fat, and processed food; the pathways they leave unblocked are real.
Leg pain during walking is a symptom many people dismiss as ordinary aging. In fact, it can signal peripheral artery disease — plaque in the leg arteries — which is a strong marker of cardiovascular disease throughout the body.
The deeper argument Dr. Prakash is making is one of agency. Genetics shapes risk, but lifestyle choices carry more weight for most people. Sedentary habits, poor diet, chronic stress, and untreated conditions are the true engines of this epidemic — and they are, in meaningful ways, interruptible. Clogged arteries are not an inevitable sentence. They are, in many cases, the accumulated result of inattention that can still be addressed. The disease moves quietly. The response cannot afford to.
Somewhere in India right now, a person is going about their day — eating, working, sleeping — with no idea that their arteries are quietly narrowing. No chest pain, no shortness of breath, no warning. That is the central and most dangerous fact about atherosclerosis, the condition in which fatty deposits accumulate inside artery walls, hardening them and choking off blood flow over years or decades. And it is the fact that Dr. V S Prakash, Director of the Ramaiah Institute of Cardiac Sciences at Ramaiah Memorial Hospital, most wants people to understand.
The numbers behind this quiet epidemic are staggering. An estimated 150 million Indians were living with cardiovascular disease or clogged arteries in 2025 — roughly 11 percent of the country's adult population. That figure alone demands attention. But what makes the situation harder to address is the fog of misconception surrounding how arteries actually become blocked, and what can realistically be done about it.
At its core, atherosclerosis is a disease of accumulated injury. The arterial lining — that smooth inner surface that blood glides across — gets damaged repeatedly by persistent inflammation, elevated blood pressure, high blood sugar, elevated cholesterol, and cigarette smoke. Each insult leaves a kind of wound. Over time, the body's repair response deposits fatty material at those wound sites. That material hardens into plaque, the artery narrows, and blood flow becomes labored. The end results, when things go badly, are heart attacks and strokes.
The first myth Dr. Prakash wants to dismantle is the belief that you'll know when something is wrong. You often won't. Significant arterial narrowing, dangerously high cholesterol, and elevated blood pressure can all coexist with a complete absence of symptoms. By the time chest pain or breathlessness arrives, the disease has frequently already reached a serious stage. The practical implication is straightforward: regular check-ups, blood pressure monitoring, and cholesterol testing are not optional extras for people who feel unwell — they are the only reliable way to catch the problem while it is still manageable.
A second misconception involves diabetes. Many people assume that once they are on medication to control blood sugar, their heart risk is similarly controlled. It isn't. High blood sugar accelerates plaque formation and damages blood vessels even in people who feel perfectly healthy and are taking their prescribed doses. Medication is one layer of protection, not the whole structure. Diet, physical activity, weight management, and stress reduction have to be part of the picture too.
There is also a tendency to misread leg pain. Cramping, aching, or numbness in the legs during a walk is sometimes written off as a sign of aging or overexertion. In reality, it can be peripheral artery disease — plaque buildup in the leg arteries — which is itself a strong indicator of cardiovascular disease elsewhere in the body. It is not something to walk off and forget.
Cholesterol-lowering drugs carry their own misconception: that taking them grants license to eat poorly. They don't. Excess sugar, saturated fat, and processed food raise blood pressure and feed plaque formation through pathways that statins don't fully block. A heart-healthy diet built around fruits, vegetables, whole grains, and lean protein remains essential regardless of what's in the medicine cabinet.
The larger point Dr. Prakash is making is one of agency. Genetics plays a role in cardiovascular risk, but lifestyle choices carry more weight for most people. Sedentary habits, processed food dependence, unmanaged stress, and untreated chronic conditions are the real engines of this epidemic — and they are, to a meaningful degree, changeable. Clogged arteries are not an inevitable sentence. They are, in many cases, the accumulated result of choices and inattention that can be interrupted.
With 150 million people already affected and the burden showing no sign of easing, the argument for early screening and sustained lifestyle change has never been more urgent. The disease moves quietly. The response cannot afford to.
Citas Notables
Lifestyle choices are generally the greater influence on arterial health, even when genetics plays a role — sedentary habits, processed food, uncontrolled diabetes, and stress all accelerate plaque buildup.— Dr. V S Prakash, Director, Ramaiah Institute of Cardiac Sciences
Cholesterol-lowering medication does not give a free pass to eat poorly — excess sugar and saturated fat raise blood pressure and feed plaque formation through pathways drugs don't fully block.— Dr. V S Prakash, Director, Ramaiah Institute of Cardiac Sciences
La Conversación del Hearth Otra perspectiva de la historia
Why does it matter so much that people know this disease is silent?
Because the silence is what lets it advance. People wait for a signal that something is wrong, and with atherosclerosis, that signal often doesn't come until the damage is already serious.
So the absence of symptoms is itself a kind of trap?
Exactly. Feeling fine is not the same as being fine. That gap between subjective experience and actual arterial health is where a lot of people get caught.
The 150 million figure is enormous. Does that suggest the problem is getting worse, or just better counted?
Probably both. Urbanization, processed food, sedentary work — these have genuinely expanded the risk pool. But better data collection also means we're seeing what was always there.
What surprised you most in what the cardiologist was saying?
The point about cholesterol medication. People treat a prescription like a solved problem. But the drug addresses one variable in a system with many moving parts.
And the leg pain point — that seems like something most people would completely miss.
It does. Leg cramping on a walk reads as ordinary wear and tear. But it can be the body's way of flagging that the same process happening in the coronary arteries is happening in the legs too.
Is the genetics-versus-lifestyle debate settled, then?
Not entirely, but the weight of evidence leans toward lifestyle as the dominant factor for most people. Genetics loads the gun; how you live largely determines whether it fires.
What's the single most actionable thing someone takes away from this?
Get checked before you feel sick. The window where intervention is most effective is the window where you feel completely normal.