Nearly 480,000 adults. One blood marker, GlycA, that tracks long term inflammation. And on their heart scans, changes almost none of them could feel. Walls a little thicker. Chambers a little smaller. The heart filling a little less well.
Take the highest fifth for inflammation. They carried a 43 per cent higher risk of heart attack and stroke than the lowest fifth. European Journal of Preventive Cardiology, this month.
The study names what drives it, and it names what can be changed: smoking, and weight. What it does not say is who helps a person change them. Nor what to do once the heart has already begun to stiffen.
That is the whole of my work.
Physician supervised, exercise based cardiac rehab is not advice to exercise. It is a prescription, written for one heart, watched while it is taken.
Here is how it acts on this exact problem.
It raises the work the heart can do before it strains. Effort is graded upward week by week, under watch, so the muscle adapts instead of being overloaded.
It works on the blood vessels. Regular aerobic training improves how arteries relax and open. Those vessel linings are the first tissue that long term inflammation damages.
It goes straight at the two things the study names. Weight falls with sustained aerobic work. Stopping smoking is part of the programme, not a leaflet handed over at discharge.
And it is safe for the people who need it most. A person whose heart is already stiff is usually told to rest. Under supervision, with the heart watched while the effort rises, that same person can train. That is the difference between a gym and a rehab programme.
Does it work? A Cochrane review of 63 trials and 14,486 people with coronary heart disease:
Deaths from heart disease fell from 10.4 per cent to 7.6 per cent.
Hospital admissions fell from 30.7 per cent to 26.1 per cent.
Now the part that should trouble any doctor. Cardiac rehab is one of the least used treatments in cardiology. Most people who qualify for it are never sent. It does not come in a box and nobody markets it, so it is quietly left out of the plan.
The heart does not fail in a day. It stiffens quietly, over years, while the person feels well and every routine test reads normal. There is a long window in there, and it is the window this programme is built for.
Ask for it. Ask for it before the surgery, and after it.
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