Author: Sequoia Capital

Key Takeaways

• This article is a heart health action guide for entrepreneurs: from risk identification, self-testing, daily prevention to emergency first aid, it systematically sorts out the heart health knowledge that entrepreneurs need to know most.

• The daily life of an entrepreneur is itself a high-risk list: long-term high pressure, lack of sleep, overwork, and the neglect of traditional risk factors—these are often not occasional occurrences for entrepreneurs, but rather a structural coexistence.

• One indicator often overlooked in health check packages is slightly elevated troponin levels, which carries a high risk even without symptoms of acute heart disease.

• “I’m still young” and “I exercise regularly” may be false feelings of security: many sudden problems are hard to predict, and the vast majority of cardiac arrests occur in “low-risk groups”; exercise is good, but excessive exercise and anaerobic exercise may be a trigger for a heart with underlying problems.

• In case of a sudden heart attack, the first step is to call 120: the ambulance has equipment and medical staff, and treatment can begin en route.

Why entrepreneurs?

Data shows that approximately one million new cases of myocardial infarction occur in my country each year, and the incidence rate among people under 50 is steadily increasing. Entrepreneurs, due to chronic stress, lack of sleep, and overwork, are among the highest-risk groups. Therefore, we have compiled a heart health action guide for entrepreneurs, covering risk identification, self-testing, daily prevention, and emergency first aid, hoping to provide some assistance to those currently starting their own businesses.

1. Chronic high stress: Cortisol is quietly damaging your blood vessels.

Stress is more than just emotional exhaustion. Sustained psychological stress leads to chronically high cortisol levels, which directly damage the inner walls of blood vessels and accelerate the process of atherosclerosis—one of the core pathological mechanisms of heart disease. Entrepreneurs face an even higher level of sustained pressure than most: financing pressure, market pressure, team pressure… These pressures don't disappear with a successful pitch or impressive data; they are structural and long-term.

2. Lack of sleep: The less you sleep, the more your heart has to work.

Sleeping less than 6 hours a day can lead to persistently high blood pressure, increasing risks to the heart and brain, and significantly raising the risk of death. The study also indicates that working more than 13 hours a day is a critical threshold that requires special attention.

3. Overwork: This is not a metaphor, but a medical diagnosis.

"Death from overwork" sounds like a sociological concept, but its real killer is heart disease. People with vascular disease or coronary heart disease may experience a sharp rise in blood pressure in a short period of time when they are under continuous high pressure and excessive fatigue, which can interrupt the blood supply to the heart and lead to sudden death.

4. Traditional risk factors: amplified and compounded in entrepreneurs.

Smoking, high blood pressure, high cholesterol, and diabetes—the Framingham Heart Study, spanning decades, has systematically confirmed that these four factors are the core causes of heart disease. Among entrepreneurs, these factors are often overlooked for a long time due to being "too busy," and by the time they are discovered, it is often no longer a single problem.

How is your heart now?

When was the last physical exam for many people? Two years ago? Three years ago? Or they can't even remember. Being busy is the most common excuse. But your heart won't stop its processes of change just because you're busy.

These items must be checked during a physical examination.

With a wide variety of health checkup packages available, which ones are truly relevant to heart health? Below is a core list compiled by several professional institutions, along with reference values.

■Basic blood indicators

• Blood lipids (total cholesterol, LDL-C (low-density lipoprotein cholesterol), HDL-C (high-density lipoprotein cholesterol), triglycerides): LDL-C is the most critical indicator—patients with coronary heart disease need to control it to <1.8 mmol/L. If they have experienced more than two acute myocardial infarctions within one year, or have hypertension, diabetes, or smoking habits, they need to further reduce it to <1.4 mmol/L.

• Blood glucose (fasting blood glucose + glycated hemoglobin HbA1c): Glycated hemoglobin reflects the average blood glucose level over the past 2–3 months. Diabetic patients need to control their blood glucose level to <7% and fasting blood glucose to between 4.4-7 mmol/L.

• Blood pressure: Target value <140/90 mmHg; those with diabetes or kidney disease need to be more strictly controlled, with a target value of <130/80 mmHg.

■ Heart Structure

• Electrocardiogram (routine + Holter monitoring): One crucial point to understand is that a normal electrocardiogram does not guarantee the absence of coronary artery disease. Atherosclerosis cannot be detected on an electrocardiogram, but Holter monitoring can record continuously for 24 hours, capturing occasional arrhythmias.

• Echocardiography: This assesses the structure and function of the heart and is the next step when a routine electrocardiogram (ECG) reveals abnormalities.

■Body type indicators

• BMI: Controlled between 18.5–23.9 kg/m²; waist circumference <90cm for men and <85cm for women. Abdominal obesity often poses a more direct threat to the heart than weight itself.

■The most important indicator worth highlighting: Troponin

A large-scale study involving over 250,000 patients, published in The BMJ (British Medical Journal), found that even a slight increase in troponin—even without symptoms of acute heart disease—increased the mortality risk in people aged 18–29 by more than 10 times. This indicator was previously only tested in the emergency room when a heart attack was confirmed, but the new research shows it is also valuable for early risk screening.

If you have a family history of heart disease, chronic high blood pressure, or other abnormal indicators found during a physical examination, you can proactively ask your doctor to test your troponin levels. Those with a family history or existing abnormalities can further consult their doctor to determine if further coronary CT/angiography, cardiac MRI, or cardiac electrophysiological studies are necessary.

Self-test: Identify your risks daily.

A physical exam is an annual "snapshot," but your heart is working in real time. Here are some daily self-monitoring methods recommended by the American Heart Association.

■Smartwatches:

The most basic heart rate monitoring tool

Smartwatches that support heart rate monitoring can continuously record resting and exercise heart rates, issuing alerts when the heart rate deviates from the normal range. For entrepreneurs, this is the most accessible tool for monitoring heart health. Some newer devices already support blood oxygen monitoring and heart rhythm abnormality alerts—if the device issues an abnormal alert, don't ignore it; get a proper electrocardiogram (ECG) to confirm.

■Blood pressure monitor:

There should be one at home.

It is recommended to regularly measure your resting pulse and blood pressure to monitor your heart health. Blood pressure monitors are inexpensive and easy to use; simply measure your blood pressure once in the morning, and the reading will tell you your condition for the day.

■Self-inspection checklist:

Don't ignore these signals

The following symptoms should be taken seriously, especially for men over 35:

• Unexplained dizziness and blurred vision, especially after physical activity;

• Chest tightness, unexplained cold sweats lasting for more than a few minutes, with no significant relief after rest;

• Shortness of breath, and it is easier to get out of breath than before when doing the same things;

• Palpitation, feeling your heart beating irregularly or suddenly accelerating.

Alternatively, you can conduct the following self-assessment:

Do you sleep less than 7 hours a day?

• Do you feel “anxious or highly stressed” more than 3 days a week?

• Do you stay in your chair for extended periods (more than 90 minutes continuously)?

• Have you used "no time" as an excuse to not exercise for more than two consecutive weeks?

• Do you rely on caffeine or energy drinks to maintain your work performance?

• Have you not had a complete "unwind" or rest for more than 3 months?

Do you experience persistent fatigue that doesn't subside even with rest?

If you answered "yes" to more than 3 of the questions, your cardiovascular risk is significantly higher than normal.

What can we do in our daily lives to truly protect our heart?

Knowing where the risks lie and knowing which metrics to check—that's the level of awareness. But awareness cannot replace action. This section discusses what entrepreneurs can actually do in their daily lives. Let's start with cognition, because there are a few misconceptions that, if not dispelled first, might cause your brain to selectively filter out the habit suggestions that follow.

Myth 1:

"I exercise regularly, so I'm relatively safe."

Exercise is not wrong, but it's not a shield. In fact, excessive exercise intensity is itself a risk factor. The risk of more serious exercise-related complications, including myocardial infarction and sudden cardiac death, increases with the intensity, frequency, and duration of exercise. Furthermore, sudden cardiac death is difficult to predict—a significant proportion of cardiac arrests occur precisely in so-called "low-risk individuals."

Exercise is an important way to protect the heart, but it must be moderate, aerobic, and gradual. High-intensity anaerobic exercise can be the final straw for people with underlying vascular disease.

Myth 2:

"I'm still young, these things are far removed from my life."

According to recent statistics from the *Chinese Journal of Cardiovascular Disease*, more than one million new cases of myocardial infarction occur in China every year, and the incidence rate among people under 50 is steadily rising. "Youth" is becoming a false sense of security. Heart damage is a long-term process; hidden dangers sown in one's 30s can manifest in one's early 40s.

Myth 3:

There are distinct sensations before a heart attack.

Not necessarily. Sudden cardiac death rarely has any warning signs; even with myocardial infarction, a significant proportion of people present with atypical symptoms—the elderly may only experience weakness and dizziness, and diabetic patients may even be completely asymptomatic, a condition medically termed "silent myocardial infarction." Relying on "feelings" to determine one's safety is a dangerous gamble.

Then, make these things a habit.

■Sports:

150 minutes of aerobic exercise per week

Many cardiovascular guidelines recommend at least 150 minutes of moderate-intensity aerobic exercise per week—brisk walking, jogging, swimming, and cycling all count, with a gradual increase. One crucial point to remember: heart disease patients should avoid high-intensity anaerobic exercise (sprinting, heavy weightlifting, high-intensity interval training, etc.). For individuals with multiple risk factors but not yet diagnosed, a stress test is recommended before engaging in high-intensity exercise.

■Diet:

Two most worthwhile things to do

There's no need to turn your diet into a project. There are two things that, if done well, will be very effective:

• Control salt intake: Limit daily salt intake to <5g (about one beer bottle cap). High salt intake is the most direct cause of high blood pressure, which is one of the core risk factors for heart disease.

• Increase dietary fiber: The daily target is over 25g – vegetables (300-500g/day), fruits (200-350g/day), and whole grains (50-150g/day) are all good sources. Most people actually consume far less than this standard.

■Sleep:

Six hours is the minimum, not the goal.

Sleeping less than 6 hours a day leads to persistently high blood pressure and a significantly increased burden on the heart. "6 hours" is a safe baseline, not a number to be proud of. If you truly cannot guarantee the length of sleep, at least ensure the quality: maintain consistent bedtime and wake-up time, and put down your phone an hour before bed.

The above three points—exercise, diet, and sleep—essentially all do the same thing: reduce the long-term burden of chronic inflammation in the body and decrease the continuous wear and tear on the cardiovascular system. Achieving any one of these is like extending the life of your heart.

■ Quit smoking and limit alcohol consumption:

It's harder than I imagined, but worth persevering through.

Tobacco's damage to the cardiovascular system is direct and continuous, as is that of secondhand smoke. Regarding the upper limit for alcohol consumption: men should consume ≤25g of alcohol per day, and women ≤15g. In business settings, "drinking less" is often harder than imagined—but it's a line worth sticking to.

■ Regular medical checkups and keeping a first-aid kit at home

A complete heart-related physical examination once a year is the most cost-effective way to manage risk. In addition, it is recommended that families keep the following items at home and ensure that family members know where and how to use them: nitroglycerin (sublingual administration during an acute angina attack), aspirin (chewable in case of suspected myocardial infarction; note that it is contraindicated for those with a history of allergies or gastrointestinal bleeding), and a blood pressure monitor.

One last thing: know where the nearest AED is. Many people think AEDs are only found in airports and subway stations, but they are actually distributed in shopping malls, office buildings, and community service centers. Knowing their location in advance can save you precious time in a critical moment.

What if something really happens unexpectedly?

We've been discussing prevention. But the reality is: even if you do everything right, unexpected situations can still occur. So, when that moment comes, what can you do?

■ First identify:

The appearance of these symptoms should immediately trigger a state of alert.

• A squeezing or dull pain behind the sternum or in the precordial region, lasting for more than 30 minutes, not relieved by rest, and not completely eliminated by taking nitroglycerin;

• The pain can radiate to the left shoulder, left arm, neck, jaw, and back; some people experience upper abdominal pain, which is easily mistaken for stomach problems or indigestion.

• Accompanying symptoms: profuse sweating (cold sweat), pale complexion, cold and clammy extremities, difficulty breathing, nausea and vomiting.

Please remember this principle: it's better to be wrong than to miss a diagnosis. If any of the above symptoms appear, do not wait and see; immediately initiate emergency procedures.

■ Four steps of first aid:

Every step is crucial

Step 1: Call 120 immediately. Do not wait or drive yourself.

Many people's first reaction is to "wait and see" or "take a taxi to the hospital." Both of these choices could be fatal.

An ambulance has the equipment and medical staff to begin treatment en route. Going there on your own means giving up the most critical opportunity for medical intervention during that time.

When calling 120, please state three things: precise location (down to the house number or specific floor), description of symptoms (how many minutes the chest pain lasted), and past medical history (whether you have a history of heart disease or what medications you are currently taking).

Step 2: Lie flat on the ground, loosen your collar, and keep your airway open.

Have the patient immediately stop all activity, lie flat on the ground, and not stand or walk. Loosen the collar and belt to ensure unobstructed breathing.

If you carry nitroglycerin with you, you can take one tablet (0.5mg) sublingually, repeating every 5 minutes, up to a maximum of 3 times.

In addition, it is important to note the contraindications for sublingual nitroglycerin: it is prohibited for those with blood pressure below 90/60 mmHg, heart rate below 50 beats/min, or a history of glaucoma.

Step 3: If the patient loses consciousness, begin CPR immediately.

Unconsciousness + no normal breathing (or only dying gasps) + no carotid pulse – if all three are present, cardiopulmonary resuscitation (CPR) should be started immediately.

• Position: Place your hands together, with the heels of your palms on the midpoint of the line connecting your nipples;

• Pressure: Press vertically downwards for 5–6 cm, and completely relax after each press, allowing the chest to rebound naturally;

• Frequency: 100–120 times/minute, with the pressing and relaxing time being roughly equal;

• Artificial respiration: Perform 2 rescue breaths for every 30 chest compressions. If you don't know how to perform artificial respiration, chest compressions alone are also effective. Don't stop just because you don't know how to perform artificial respiration.

The purpose of CPR is to maintain basic blood circulation and buy time for defibrillation—keep doing it until emergency personnel arrive.

Step 4: Locate the AED and turn it on.

An AED (Automated External Defibrillator) is a device that can be operated by ordinary people. The machine provides voice guidance for each step. Operating procedure: Turn on the device → Follow the prompts to attach the two electrode pads → The AED automatically analyzes the heart rhythm → Follow the prompts to defibrillate → Immediately continue CPR until emergency personnel take over.

In conclusion

There is only one heart. There are about 2 to 3 billion heart muscle cells, and a serious heart attack can permanently lose about 1 billion of them—they cannot regenerate.

Many entrepreneurs may occasionally gamble on uncertainty or overextend themselves for speed. But your own heart is not a gamble, and your health cannot be overdrawn. Develop the habit of regular checkups and go to bed early—these are the most important long-term investments you can make for your company.