Heart attack clues start about 10 years earlier, warns CMC Vellore-trained doctor. And most people miss them

Heart attacks often catch people by surprise, but emerging evidence shows that warning signs can start nearly ten years before the event. Many individuals miss these early indicators because they are subtle and develop gradually over time. Declining physical activity, in particular, has been identified as a key early clue that signals the risk of future cardiovascular problems.

This finding comes from experts, including Dr. Sudhir Kumar, a neurologist trained at CMC Vellore and currently practising at Apollo Hospitals in Hyderabad.

Early Decline in Physical Activity as a Red Flag

Dr. Kumar points out in an X post that moderate-to-vigorous physical activity (MVPA)—activities like brisk walking, cycling, or swimming—begins to fall around 12 years before cardiovascular disease is diagnosed. While some reduction in physical activity is normal with age, the decline is much sharper and more significant in those who later develop heart disease, especially in the two years before diagnosis.

This pattern suggests that a steady drop in physical activity is more than a natural part of aging; it can be an early sign of underlying heart problems.

▶️Moderate-to-Vigorous Physical Activity (MVPA) starts to decline about 12 years prior to diagnosis of cardiovascular diseases (CVDs) such as heart attack, stroke, heart failure, with a more rapid decline about two years prior to CVD diagnosis.

▶️A decline in MVPA is common in… pic.twitter.com/yaGyqyCuoc

— Dr Sudhir Kumar MD DM (@hyderabaddoctor) August 10, 2025

The Coronary Artery Risk Development in Young Adults (CARDIA) study, published in JAMA Cardiology, echoes these findings. Researchers followed participants from young adulthood to midlife and observed that those who eventually suffered cardiovascular events showed a marked and steady decline in physical activity starting about 12 years before the event, with a faster drop in the last two years.

The study also revealed that Black women had the lowest activity levels throughout adulthood and faced greater risks after cardiovascular incidents.

Importance of Sustained Physical Activity

Experts emphasize maintaining regular moderate-to-vigorous physical activity for at least 150 minutes weekly throughout life. Dr. Kumar advises that waiting for a heart event before becoming active is too late. Instead, building and sustaining healthy activity habits early on is crucial to reducing risk. After any heart-related episode, gradual resumption of physical activity with medical guidance supports recovery and long-term heart health.

Consistent physical activity remains the most effective way to prevent heart disease and improve outcomes after a cardiac event. Recognizing early clues like declining activity can prompt timely medical attention. Staying active throughout adulthood is essential for protecting heart health over a lifetime.