Your cardiometabolic scorecard: Neurologist explains the silent force behind heart and stroke risk

Cardiometabolic health—a fusion of cardiovascular and metabolic well-being—is vital in determining one’s risk for heart attack and stroke. The incidence of stroke in India has doubled in the last two decades. Most metro cities witness approximately 50 acute strokes every day.

Core risk factors include hypertension, dyslipidemia, insulin resistance or diabetes, obesity (especially abdominal), and lifestyle elements like physical inactivity or smoking. These factors often cluster into metabolic syndrome. Addressing each of these five key areas can significantly enhance your health scorecard and lower your risk of life-threatening events.

Hypertension is one of the most significant and modifiable risk factors for both heart attack and stroke. Globally, the prevalence has risen alarmingly, with the number of individuals affected increasing from approximately 972 million in 2000 to a projected 1.56 billion by 2025. Persistent, uncontrolled high blood pressure is recognized as the leading preventable cause of stroke, and it also plays a pivotal role in the development of coronary artery disease and myocardial infarction. By exerting continuous strain on the vascular system, hypertension accelerates atherosclerosis, damages arterial walls, and contributes to plaque formation, thereby substantially heightening the risk of life-threatening cardiovascular events.

Elevated LDL ("bad") cholesterol, low HDL (“good”) cholesterol, and high triglycerides significantly raise the risk of atherosclerosis—the buildup of arterial plaque that triggers heart attacks and strokes
Moreover, the TyG-WWI index—a composite measure combining triglycerides, blood sugar, weight, and waist size—has been shown to predict stroke risk: individuals in the highest risk category experienced up to a 38% greater stroke risk compared to those in the lowest

Diabetes and insulin resistance are among the strongest predictors of cardiovascular disease, substantially elevating the risk of both heart attack and stroke. Individuals with diabetes are estimated to have a two- to threefold higher likelihood of experiencing a stroke compared to those without the condition.As the amount of sugar in the body increases, the amount of fat accumulates in the walls of the blood vessels. If this continues, the blood vessels get blocked and the blood flow gradually decreases.. When hyperglycemia is accompanied by additional factors such as hypertension, dyslipidemia, and central obesity, it constitutes metabolic syndrome, a clinical entity that is known to double the risk of cardiovascular disease

In India, excess body weight—especially abdominal adiposity—is a potent determinant of cardiometabolic risk. National data reveal that 40% of Indian women and 12% of men exhibit abdominal obesity, a metabolic risk factor even when overall body mass index (BMI) is within normal limits. Overweight or obesity is widespread: nearly 20% of Indian women and 19% of men are overweight or obese nationwide, with significantly higher rates in certain states such as Delhi, Chandigarh, and Kerala. Among urban Indians, the impact of obesity is striking—60% of obese individuals in South India, for example, meet criteria for metabolic syndrome, compared to only around 22% of their normal-weight counterparts

Incorporate sustained weight loss and monitor waist circumference alongside BMI.
Ensure policies like public health campaigns support healthy eating and activity
Screen for blood glucose levels and manage blood sugar through diet, physical activity, and medication if required.
Adopt a balanced diet rich in whole grains, lean proteins, and healthy fats; limit trans fats and added sugars or a heart-healthy diet (e.g., DASH or Mediterranean style)
Getting regular lipid profiling starting in your 20s, alongside BMI and waist circumference checks
Engage in regular physical activity
Follow updated guidelines emphasizing early detection and individualized treatment.
Prioritize sleep and stress management (e.g., meditation, hobbies).
Use risk calculators, like the updated PREVENT tool for 10- and 30-year cardiovascular risk
Composite markers like TyG-WWI or even advanced imaging such as left ventricular MRI may offer predictive insights
Collaborate with healthcare professionals to monitor and manage risk proactively.

Prominent daily habits that slash risk include 30 minutes of daily exercise, a balanced diet, adequate sleep (7–9 hours), hydration, and even moderate coffee consumption for antioxidant benefit.
The interplay of hypertension, dyslipidemia, insulin resistance/diabetes, obesity, and lifestyle behaviors shapes your cardiometabolic health—and ultimately your risk of heart attack or stroke. By systematically improving each domain through informed action and regular monitoring, you can significantly elevate your health scorecard and protect your future cardiovascular wellbeing.

Dr (Prof.) Suryanarayana Sharma PM, Senior consultant neurologist and stroke specialist, Apollo Hospitals Bannerghatta Road, Bangalore