Heart attacks don’t begin in the heart: Cardiologist shares the first problem to fix to reduce cardiac risk

When heart attacks strike, they are often seen as sudden, dramatic events. However, cardiologists increasingly argue that the damage begins quietly, years earlier. According to Dr Sanjay Bhojraj, an interventional cardiologist based in the United States, the root cause behind most heart attacks is not always blocked arteries alone, but chronic inflammation that remains undetected and unmanaged for long periods.

A cardiologist’s shift from treatment to prevention

In a recent Instagram post, Dr Bhojraj shared a message that resonated widely online. He wrote that most heart attacks start with one core problem and that addressing it early can significantly reduce heart risk. Drawing from years of clinical experience, he explained that he made a conscious decision early in his medical training to focus not on treating heart attacks after they occur, but on preventing them altogether.

According to Dr Bhojraj, waiting for symptoms or abnormal test results often means the disease process is already well underway. His work in preventive and functional cardiology led him to identify hidden drivers of heart disease such as chronic inflammation, metabolic strain and unmanaged stress, factors that may exist for years before any red flags appear in routine scans or lab reports.

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A post shared by Sanjay Bhojraj MD | Functional Medicine Doctor (@doctorsanjaymd)

Inflammation as the hidden trigger

Health experts note that inflammation is a natural and essential immune response. As explained in a Healthline report, inflammation helps the body heal from infections and injuries. Problems arise when inflammation becomes chronic. Unlike acute inflammation, which resolves within days or weeks, chronic inflammation can persist for months or years and has been linked to heart disease, autoimmune disorders and prolonged stress.

The Healthline report outlines that chronic inflammation often operates silently. While some people experience symptoms such as fatigue, body pain, digestive issues or mood disturbances, others may not notice any obvious warning signs until serious complications develop.

How chronic inflammation harms the heart

Cardiologists point out that long-term inflammation can damage blood vessels, accelerate plaque buildup in arteries and impair vascular function. Over time, this creates the conditions for heart attacks and other cardiovascular events. Dr Bhojraj emphasizes that by the time chest pain or abnormal cardiac tests appear, the underlying inflammatory process may already be advanced.

His approach focuses on reducing inflammation early to protect vascular health before damage becomes irreversible. The goal, he says, is not just longer life but healthier aging with sustained energy and resilience.

What drives inflammation in daily life

According to the Healthline report, several factors can contribute to chronic inflammation. These include recurrent infections, certain medications, autoimmune conditions, exposure to irritants and dietary habits. Diets high in sugar, refined carbohydrates, trans fats and alcohol have been linked to persistent inflammation.

Stress also plays a significant role. Prolonged psychological stress can keep the immune system in a constant state of activation, further increasing inflammatory markers linked to heart disease.

Can inflammation be detected early?

There is no single test that definitively diagnoses chronic inflammation. However, doctors may use blood markers such as C-reactive protein, erythrocyte sedimentation rate and fibrinogen levels to assess inflammatory activity, as noted in the Healthline report. These tests do not pinpoint the exact cause but can indicate that inflammation is present and needs attention.

Reducing risk before symptoms appear

Both Dr Bhojraj and medical research emphasize lifestyle changes as a powerful tool against inflammation. The Healthline report highlights anti-inflammatory foods such as berries, fatty fish, green tea, turmeric and vegetables like broccoli and tomatoes. Regular moderate exercise, stress management, adequate sleep and quitting smoking are also key steps in lowering inflammation levels.

Dr Bhojraj, who is also the founder of the wellness program Well12, integrates nutrition, sleep optimization, breathwork and stress management into heart care. His work combines advanced lipid testing and genomic medicine with lifestyle interventions aimed at tackling disease at its roots.