Men and Heart Disease: What You Need to Know Before It’s Too Late

By Dr Phan Nop, Head of Emergency Services, Wellness, and Primary Care

When we think about heart attacks or cardiovascular disease, we often picture middle-aged or elderly men. But that assumption is becoming dangerously outdated. The truth is, heart disease doesn’t wait for old age — the seeds are often sown well before the age of 40.

In Malaysia, heart disease has remained the leading cause of death among men for many years. Ischaemic heart disease accounted for 17.6% (12,648) of male deaths in 2023. Even more alarming is the growing number of young Malaysian men turning up in hospitals with signs of cardiovascular disease — some in their 30s, others even younger. Sadly, many of these cases are only detected during medical emergencies, such as heart attacks or strokes.

This article explores why younger men are increasingly at risk, what early warning signs to watch out for, and most importantly, what steps you can take today to protect your heart — before it’s too late.

Why Are Younger Men Becoming More Vulnerable?

1. Modern Lifestyle Hazards

Life today is a far cry from that of previous generations. Long working hours, stressful jobs, poor diets, excessive screen time, and disrupted sleep have all contributed to a rising tide of poor cardiovascular health — with younger men bearing the brunt.

• Sedentary lifestyles: Desk-bound jobs and reduced physical activity slow down metabolism and increase the risk of obesity and insulin resistance.
• Stress and burnout: Chronic stress elevates cortisol, which in turn can raise blood pressure and cholesterol levels.
• Unhealthy diet: High consumption of processed foods, sugary drinks, and saturated fats contributes to weight gain and blocked arteries.
• Smoking and vaping: Despite better awareness, many young men still smoke or vape regularly — both significantly heighten cardiovascular risk.
• Lack of regular check-ups: Many young men avoid seeing a doctor unless they’re unwell, meaning early signs of hypertension or high cholesterol often go unnoticed.

2. Genetics and Family History

Your family history matters. If your father, brother, or uncles had a heart attack or stroke before the age of 55, your risk is substantially higher — even if you feel perfectly healthy. Inherited conditions such as familial hypercholesterolaemia, hypertension, or diabetes can silently increase your risk long before symptoms appear.

Heart Disease in Men Under 40: What Does It Look Like?

Heart disease doesn’t always announce itself with chest pain. For younger men, the signs can be subtle — or completely silent.

Here are some early findings to be aware of:

• Elevated blood pressure (hypertension) – even borderline readings can be dangerous over time
• Raised LDL cholesterol – the “bad” cholesterol that contributes to plaque buildup in the arteries
• Low HDL cholesterol – the “good” cholesterol that helps remove excess cholesterol from the bloodstream
• Insulin resistance or prediabetes – early signs of metabolic syndrome
• Fatty liver disease (NAFLD) – increasingly common in overweight young men and strongly linked to cardiovascular risk

Most of these conditions are asymptomatic — you won’t feel anything until damage has already begun or a crisis strikes.

The First Symptom Could Be the Last

In some young men, the first sign of heart disease is sudden cardiac death. A study by the American Heart Association found that up to 10% of all heart attacks occur in men under 45. Locally, emergency departments are seeing cases of young men collapsing during workouts, under stress, or even at rest — often with no known history of heart issues.

This is why prevention isn’t optional — it’s essential.

What Can You Do? The Power of Early Screening

Early detection saves lives. The aim isn’t to label yourself as “sick,” but to understand your risk and take steps before permanent damage occurs. For men under 40, we recommend screening for:

1. Cardiovascular Risk Markers

• Blood pressure
• Fasting glucose & HbA1c – to detect diabetes or prediabetes
• Lipid profile – total cholesterol, LDL, HDL, triglycerides
• High-sensitivity CRP – a marker of inflammation linked to heart disease
• Lipoprotein(a) – a genetic risk factor often missed in standard tests
• CT cardiac calcium scoring – detects calcium deposits in coronary arteries

2. Heart Function Tests

• Resting ECG – detects irregular heart rhythms or silent past heart attacks
• Stress or treadmill test – for those with symptoms or risk factors
• Echocardiogram – assesses the heart’s structure and function

3. Lifestyle & Metabolic Assessment

• BMI and waist circumference
• Body composition analysis – fat versus muscle ratio
• Liver and kidney function tests

Early identification allows you to make positive changes or start treatment while your heart is still healthy and strong.

Lifestyle Changes That Can Save Your Life

You don’t have to wait for a warning sign. You can start reducing your risk today:

• Get moving: Aim for at least 150 minutes of moderate exercise or 75 minutes of vigorous activity weekly
• Include strength training at least twice a week
• Avoid prolonged sitting — stand, stretch, or walk every hour
• Eat for your heart: Prioritise vegetables, fruits, whole grains, legumes, and lean proteins
• Reduce intake of processed food, sugary drinks, and fried items
• Choose healthy fats like those in nuts, olive oil, and fatty fish
• Quit smoking and vaping: Both significantly raise your risk — vaping is not a safe alternative
• Prioritise sleep and stress management: Aim for 7–9 hours of sleep per night
• Practice stress-reducing habits: mindfulness, deep breathing, exercise, or hobbies
• Get regular check-ups: Annual screenings can detect early warning signs, even if you feel fine

Heart disease isn’t just a disease of old age — it’s a disease of lifestyle, time, and neglect. You have the power to protect your heart health in your 20s and 30s — not just after a wake-up call in your 50s. Taking steps today means safeguarding your ability to work, love, and live fully tomorrow.