Diabetes can mask heart attack pain, warns Dr Devi Shetty: ‘Nearly 50% develop it without chest pain’

India is home to one of the world’s largest populations of people living with diabetes, and according to cardiac surgeon Dr Devi Shetty, this is one of the biggest reasons silent heart attacks are so common in the country. Speaking to ANI, he said diabetes can reduce pain sensation, meaning that the classic warning sign of crushing chest pain may never appear.

Instead, a person may experience only unusual tiredness, sweating, mild discomfort, nausea or slight breathlessness, symptoms that are often ignored because they seem too ordinary. This is well recognised in medical research: the National Institute of Diabetes and Digestive and Kidney Diseases in the United States explains that people with diabetes are more likely to experience ‘silent’ heart attacks because nerve damage can affect pain perception.

Dr Shetty said nearly 50% of patients with blockage in their coronary arteries have no symptoms, and nearly 50% develop a heart attack without any previous chest pain, especially diabetics. ‘How fit people feel has nothing to do with how fit they actually are. You can have a very serious heart problem and still not know it,’ he said.

This makes regular heart screening particularly important for people with diabetes. Citing recommendations from the Cardiological Society of India, Dr Shetty said people with longstanding diabetes should undergo heart evaluation even earlier than the general population, based on medical advice, alongside broader guidance that every Indian should know their cholesterol level from around the late teenage years.

A basic evaluation, he said, may include blood tests, an electrocardiogram, an echocardiogram and a cardiac CT scan when recommended by a doctor. ‘Everyone should know their numbers, blood pressure, cholesterol and heart health,’ he said, noting that people often avoid doctors until symptoms develop, which may already be too late.