'Always on' lifestyle is damaging our hearts: Cardiac surgeon Dr Shriram Nene

India Today

3 days ago

India is no stranger to heart disease. As the number one killer in the country, cardiovascular illnesses are no longer just the concern of the elderly or high-risk groups. Viral videos of young people collapsing in the gym often without warning, younger patients lining up in OPDs, mounting stress and unhealthy lifestyles are feeding into the health fabric of the country, giving rise to more cases of this worldwide killer.advertisementAt the heart of this rising crisis is not just genetics or chance - but how we live, work, sleep, and move.Top cardiac surgeon Dr. Shriram Nene, also a health advocate, decodes the reason why so many Indians are still suffering from heart diseases, why we need to blame the "always on" culture and how to unload the digital overload to keep our body healthy.THE SILENT KILLER: SITTING
Sedentary lifestyles have become the new smoking. And in urban India, desk jobs and digital dependence are driving people toward cardiac risk.'Sitting is turning out to be one of the biggest and most silent cardiac risks in India,' Dr. Nene tells IndiaToday.in in an exclusive interview.The latest ICMR–INDIAB data shows that nearly 37% of Indian adults aren't meeting minimum activity thresholds.In a 2024 study in Kerala, people were sitting for a median of 300 minutes a day, and that was associated with a 28% increase in major adverse cardiac events over five years.These aren't fringe findings. The World Health Organisation's 2024 report labelled South Asia the least physically active region in the world, with nearly half the population inactive.'Urban desk jobs are driving this problem. We often hear of 40-year-old founders and professionals coming in with sudden cardiac arrest. These are people who stated that they 'work out' three times a week, but the rest of their time is spent sitting. The math doesn't add up. Muscles are glucose sinks. If you're not engaging them regularly, you're missing the point. It's not just about scheduled workouts, it's about what your body is doing the other 23 hours a day," says Dr. Nene.SCREEN OVERLOAD AND 'NOTIFICATION TACHYCARDIA'India is fast becoming the screen time capital of the world, and the results are now visible in medical data.There's no question that digital overload is starting to show up in clinical data, especially among younger age groups.
India is fast becoming the screen time capital of the world, and the results are now visible in medical data. ()
In India, average screen time now crosses 7.3 hours a day. Among school-going teens, we're seeing lower heart rate variability and early signs of severe high blood pressure in those with the highest screen time.Dr. Nene terms the phenomenon 'notification tachycardia.''People come in with resting heart rates above 90, evening cortisol levels that are elevated, and sleep scores that are just terrible. It's a cascade. Your system stays in a state of low-grade alert, and over time, that creates a cardio-metabolic environment that is ripe for disease. It's not one dramatic moment, it's the slow, constant toll of never switching off," he explains.STRESS, CORTISOL, AND THE CARDIAC COSTBesides this, modern stress isn't just psychological - it's biochemical. And it's rewriting how doctors understand heart disease.'Chronic stress is no longer something abstract. We now have data from Indian cohorts showing that salivary cortisol levels above 10 nanograms per millilitre are linked to a two-fold increase in stage-one hypertension and abnormal lipid profiles in young professionals,' says Dr. Nene.advertisementCortisol, the body's stress hormone, becomes harmful when constantly elevated. When sustained, it reduces the bioavailability of nitric oxide, which is essential for healthy blood vessels. It increases visceral fat, destabilises plaque, and primes the heart for stress-induced cardiomyopathy.
Cortisol, the body's stress hormone, becomes harmful when constantly elevated. ()
'What that looks like in the body is quite dramatic. These are conditions we used to view as rare complications. Today, we patients with these issues present every week to physicians in India and globally," adds Dr. Nene.INFLAMMATION, SLEEP, AND THE IRREGULAR LIFEPoor sleep and irregular schedules are silently fuelling inflammation in the body - a root cause of heart disease.And the link between poor sleep and inflammation is now well established.Even if you're clocking seven or eight hours of total sleep, if your bedtime is irregular, something that's common in industries like tech or film, your risk for heart attacks and strokes increases by 26%.advertisementThe body responds to erratic sleep with a spike in inflammatory markers.
Even if you're clocking seven or eight hours of total sleep, if your bedtime is irregular, something that's common in industries like tech or film, your risk for heart attacks and strokes increases by 26%. ()
Dr. Nene explains, "The mechanism here involves a spike in inflammatory markers like interleukin-6, TNF-alpha, and high-sensitivity CRP. Indian sleep-restriction models confirm these findings. And in real-world practice, we have noticed that treating conditions like sleep apnea often lowers CRP more effectively than adding another statin. That says something about how central sleep and stress are to inflammation and heart health.'SIMPLE SHIFTS, BIG DIFFERENCEFor busy professionals and parents who feel overwhelmed, Dr. Nene offers bite-sized changes that deliver measurable results.'Small, consistent changes are the way forward. Just standing up or walking for one minute every hour can improve how your arteries function. You can use your smartwatch to remind you," he says.In fact, if you're commuting, get off one metro stop early and add two brisk ten-minute walks into your day. During long calls, attend them while walking.advertisementThat alone can get you a thousand extra steps per meeting.Breathing techniques and digital hygiene also make a big difference.'Between emails, you can try 4-7-8 breathing. It lowers your heart rate by around five beats per minute. If you're looking for something culturally familiar, pair it with nadishodhana. And when it comes to sleep, switch off your screens at least an hour before bed. Schedule your Do-Not-Disturb mode at a fixed time, say 10 pm, to signal to your body that it's time to wind down," says Dr. Nene.
Breathing techniques and digital hygiene also make a big difference. ()
These aren't hypotheticals. The cardiac surgeon quoted a study, the INDIA-WORKS trial, that has already shown that such small workplace tweaks can reduce HbA1c and systolic blood pressure within 18 months. HbA1c measures one's glucose control levels.WADING THROUGH THE WELLNESS NOISEIn the era of viral trends and influencer advice, how can people protect themselves from misinformation? Dr. Nene says to verify it first.'Start with the source. Look at whether the information is coming from a credible authority, like the American Heart Association, the Indian Heart Journal, ICMR, or from a marketing page. Then apply what I call the three-signal test. Is the advice reproducible? Does it have a solid biological explanation? And most importantly, does it lead to actual clinical outcomes?' he says.Dr. Nene warns that digital misinformation isn't just annoying, it is, in fact, dangerous.A 2024 study on Indian cardiovascular content on Instagram found that 42% of posts were factually incorrect or incomplete. "That's not just harmless misinformation, that's the kind of stuff that leads people to make poor health decisions," he says.TRENDY DOESN'T MEAN TESTEDMany viral 'wellness' trends haven't been put through scientific scrutiny - and some are actively harmful.
Dr. Nene warns that digital misinformation isn't just annoying, it is, in fact, dangerous. ()
'I treat trends the same way I treat any new intervention, as experiments, unless proven otherwise. The problem arises when trends are marketed like cures,' Dr. Nene explains.From ice baths, which are popular in gyms is one of the reasons for cold-triggered atrial fibrillation. Yet it is trendy.'Another concern is the megadose supplement culture. Fat-soluble vitamins taken in excess can be toxic, and some of these herbal pre-workout mixes are affecting heart rhythms, prolonging the QT interval. Many of them still haven't caught the eye of regulators," adds. Nene.'My rule is simple. If a trend hasn't passed the same level of scrutiny as statins or angioplasty, I don't treat it like gospel. That's not being cynical, that's just protecting your heart," he says.WELLNESS PREVENTIONDespite the explosive growth of the wellness industry, heart disease continues to dominate India's mortality statistics. Why?The Indian wellness market is worth around Rs 13 lakh crore, and yet heart disease remains the number one killer."So clearly, something's off," Dr. Nene says. "A lot of it is one-size-fits-all, and that doesn't work in a country as genetically and socio-economically diverse as India."Another problem is the emphasis on experience over habit. "A weekend spa or a detox program might feel good, but it doesn't counteract what happens from Monday to Friday," he adds.People also focus too much on vanity metrics like weight, and not enough on clinical ones like LDL cholesterol or VO2 max. That, says Dr. Nene, gives a false sense of security.The Surgeon's Own BlueprintSo how does one of India's top cardiac surgeons walk the talk?Dr. Shriram Nene lives by a carefully designed lifestyle that combines modern science with mindful daily habits.'I follow a protocol that's tailored to my needs, but grounded in science and culture. I exercise early in the morning. That usually includes six workouts per week alternating between three high-intensity spin aerobic workouts and three whole-body strength workouts with weights. I reserve Sundays for family and recovery,' he says.His wellness routine doesn't stop at physical activity. 'My diet is vegan. For stress management, I do 10 minutes of breathing and keep a gratitude journal. Sleep is non-negotiable: I go to bed at 10:30 and wake up at 5:30. No tech in the bedroom. I track sleep with devices and anchor my circadian rhythm with sunrise activities," he says.The heart of the matter is this: India's cardiovascular crisis isn't inevitable.It is being silently shaped by how we sit, sleep, stress, scroll, and surrender to unhealthy patterns. As Dr. Nene reminds us, the answers aren't in fads, but in everyday science-backed consistency.The revolution your heart needs isn't dramatic. It's daily.- EndsMust Watch