Is start-up culture and hustle mentality increasing risk of heart-related issues? Doctors answer

Five CEOs and co-founders have passed away in the last four years, at a relatively young age. Illustration by Uday Mohite

The sudden demise of Rohan Mirchandani, former CEO and co-founder of the Greek yoghurt brand Epigamia, who passed away on December 21 aged 41, has yet again started the dialogue about heart diseases in younger men, especially in the start-up community.

In the last four years, four CEOs and co-founders have passed at a relatively young age due to cardiac arrest: Rudratej Singh, President and CEO of Royal Enfield at 46 years; Pankhuri Shrivastava, Founder of rental startup Grabhouse aged 32; Rohan Malhotra, co-founder of Good Capital, at 44; and Ambareesh Murty, co-founder and CEO of Pepperfry, at the age of 51.

It's also no news that Indians are vulnerable to cardiovascular diseases - it reportedly causes 24.8 per cent of all deaths in India in the form of heart attacks, cardiac arrests, heart valve disease, and other complications. Yet, in a small survey conducted by Sunday mid-day on social media with 300 participants aged 20 and above, over 55 per cent did not know the difference between a heart attack and a cardiac arrest - the terms are considered interchangeable.

Gone too soon: Rohan Mirchandani 41, Rudratej Singh 46, Rohan Malhotra 44, Ambareesh Murty 51 and Pankhuri Shrivastava 32

In simple terms, cardiac arrest occurs when the heart stops beating abruptly, either due to a malfunction in the heart's electrical system or a sudden change in the circulatory system. A heart attack is related to blood circulation and occurs when a blockage or narrowing of the coronary artery cuts off or reduces blood flow to the heart, causing damage due to lack of oxygen.

Dr Sunil Wani, a cardiologist at Kokilaben Dhirubhai Ambani Hospital, says, "Educating people about cardiovascular diseases, especially about the dangers of high blood pressure, diabetes, and high cholesterol is the key to its prevention and early detection."

Why are South Asians more prone to heart-related conditions? The answer lies in genetics: fewer vascular regenerative and reparative cells, lifestyle, and environmental factors like air pollution. Dr Wani says India's genetic predisposition to cardiovascular diseases is quite well-documented, with studies pointing towards multiple genes contributing to the risk of developing coronary artery disease [arteries narrowing and restricting blood flow to the heart]. "And because of such extensive studies," Dr Wani says, "If a person gets checked regularly, and seeks medical help on time, the risk of cardiovascular diseases decreases significantly."

Dr Sunil Wani and Dr Shaunak Ajinkya

Doctors recommended individuals with a family history of heart issues dating back 25 years get tested frequently.

Are men more prone to heart disease than women? The answer is yes - due to biological propensity to higher levels of low-density lipoprotein (LDL) cholesterol, AKA, "bad" cholesterol, and the fact that they are more likely to develop hypertension at younger ages. Experts say oestrogen delays the onset of heart-related issues in women until menopause by improving healthy cholesterol levels. However, at an older age [above 55], the risk of heart disease in men and women is somewhat similar.

A study conducted by Nathan Kline Institute and New York University School of Medicine suggests that men's high testosterone levels also lead them to engage in more risk-taking behaviours than women, such as frequent drinking, smoking, and other activities, despite knowing the consequences. No wonder "why women live longer" memes are some of the most longstanding on the Internet.

Borivli-based Dr Rashmi Singh, says, "Combine these factors with internal body changes that occur in men after they hit their 40s - such as reduced muscle mass and strength, increased body fat, decreased energy levels, stiffening of arteries, and a rise in cholesterol levels - they all increase the risk of heart disease."
Negligence of health is a major factor in death due to cardiovascular diseases. Doctors say many men do not undergo regular health check-ups, leading to late diagnoses of underlying conditions such as high cholesterol or prediabetes. Stating a recent example, Dr Wani says, "We handled a cardiac arrest case last week, where the man did not even know that he had diabetes."

Start-up culture and hustle mentality are also to blame. The new work norm demands long hours, in generally high-pressure environments, de-prioritising physical activity. "This sedentary lifestyle," says Dr Wani, "combined with poor diet and sleep deprivation, creates a perfect storm for heart-related issues. Professionals in demanding roles, even doctors, too, sometimes face hormonal imbalances and elevated stress levels."

Severe cardiovascular issues are not new. Dr Wani says, "The trend has persisted for over 25 years, especially among men in their 40s. But it has accelerated in recent years. India is also the diabetes capital of the world. Diabetes, obesity, and hypertension form a lethal combination that significantly raises cardiovascular risks, and the prevalence of these conditions has grown substantially in the past few decades."

However, the narrative is changing, slowly but surely. It has been reported in these columns that, unlike previous generations, Gen Z views work-life balance as a necessity, not a luxury.

Industry leaders such as Radhika Gupta, Managing Director and CEO of Edelweiss Mutual Fund, expressed shock and grief over Mirchandani's passing, emphasising self-care over work. The 41-year-old tweeted, "It is heartbreaking [sic] to see stories of so many folks I know losing their lives in their 40s and 50s to heart attacks and stress-related ailments. It makes you question a lot of things. As I get older my greatest learning to manage stress is to be grateful. Rich lists and power lists will make you believe life is a race, but there is always someone who has more ... and many who have less. Count the blessings and live the moments. [Sic]"

Chronic stress, anxiety, and depression also play significant roles in deteriorating heart health. A psychiatrist at Kokilaben Dhirubhai Ambani Hospital, Dr Shaunak Ajinkya, says, "One of the primary ways mental health affects the heart is through stress. Chronic stress releases hormones such as adrenaline and cortisol, which increase heart rate and blood pressure. Prolonged exposure of these hormones can harm the cardiovascular system." The continuous release of cortisol and other stress chemicals can damage blood vessels by causing inflammation, which may lead to coronary artery disease.

Mental health also indirectly influences heart health through its impact on sleep patterns. "Anxiety and depression often disrupt sleep, leading to conditions such as insomnia or poor sleep quality. Sleep deprivation is a known risk factor for heart disease, as it can elevate blood pressure, disrupt glucose metabolism, and increase stress hormone levels," explains Dr Ajinkya.

Addressing the argument by many start-up leaders and young businesses that we don't need a full eight hours of sleep and just four to five hours are enough, Dr Ajinkya says, "Even a cellphone can function with a 10 per cent battery, but it cannot function for as long or as efficiently. If a machine needs a recharge, imagine the human body, which is much more complex."

In our discussion with doctors about men's health in their 40s, it became clear that there is no novel issue at play that's killing men. Regarding concerns about the COVID-19 vaccine causing heart attacks, doctors stated there is no clinical evidence to support that claim.
So, it all boils down to maintaining a proper diet, adequate sleep, and dedicating at least one hour to mindfulness-based meditation or stress reduction methods, such as deep breathing, and visualisation techniques that can calm down one's nervous system. As Dr Ajinkya aptly put it, "If you can't make one hour for yourself, nobody else will."

53 yrs
Avg age of first heart attack in South Asians

58.8 yrs
Avg age of first heart attack in people of European descent

'Source: The Interheart Study

Tests for cardiovascular diseases

Blood tests: To identify high cholesterol and diabetes - both major contributors to heart disease
Electrocardiogram (ECG): Helps detect irregular heartbeat or blocked arteries
Echocardiogram: Helps detect structural abnormalities
Treadmill stress test: Identifies early signs of heart disease
Note: These have to be combined with a thorough clinical evaluation
''Source: Kokilaben Dhirubhai Ambani Hospital