Functional Decline Precedes Cardiovascular Disease Events By Many Years

TL;DR

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A study of 12,015 older adults found that people who later experienced cardiovascular events had worse frailty, intrinsic capacity and physical health-related quality of life than matched controls as far as 10 years beforehand. The differences widened in the five years before events, but the observational study does not show that functional decline causes cardiovascular disease or that a particular intervention prevents it.

A study published online September 23 in JAMA Cardiology found that older adults who later experienced cardiovascular disease events had worse measures of frailty, intrinsic capacity and physical health-related quality of life than matched peers up to a decade before the event. The findings point to a long period in which functional differences may be visible before a cardiovascular event is clinically apparent, but do not establish that those changes cause the event.

Aung Zaw Zaw Phyo of Monash University in Melbourne and colleagues analyzed data from 12,015 participants in the Aspirin in Reducing Events in the Elderly cohort. The analysis included 2,403 people who experienced a cardiovascular event and 9,612 matched controls. Researchers compared how several measures of function and aging changed in the years before the event.

Participants who later had an event had consistently less favorable profiles than controls, including higher frailty, lower intrinsic capacity and poorer physical health-related quality of life. The differences widened markedly during the five years before an event. Over time, the event group had faster worsening in two frailty measures and steeper declines in intrinsic capacity and physical quality of life, the researchers reported.

The broad pattern was similar across components of the cardiovascular disease composite, though the timing differed. Differences appeared at least 10 years before heart failure and fatal coronary heart disease, while divergence for myocardial infarction and stroke was reported later. The study describes group-level trajectories; the supplied report does not establish that these measures can predict an individual person’s event.

A Longer Window for Clinical Attention

The results suggest that cardiovascular events may be preceded by gradual changes in physical function and broader health, rather than appearing against an otherwise stable functional profile. For clinicians, the pattern may support paying attention to changes in frailty and physical capacity alongside conventional cardiovascular risk factors. The authors describe the findings as indicating a prolonged window for closer clinical evaluation and early intervention.

That possibility should not be mistaken for proof that screening with these measures prevents heart attacks, strokes or other events. The analysis is observational, and it compares trajectories among people who did and did not experience an event. It does not test a screening program or treatment, nor does it show that reversing a decline would change cardiovascular risk. The practical value of tracking these measures will need further study.

The timing also matters: if group differences emerge years in advance, research may be able to examine how functional aging relates to cardiovascular risk over time. But a population-level association is not an individual forecast. The report provides no threshold that would identify who will have an event, and functional decline can have many possible explanations.

How Researchers Compared Aging Trajectories

The study was a nested case-control analysis within the Aspirin in Reducing Events in the Elderly cohort. Researchers compared participants who went on to have cardiovascular events with matched controls, examining measures recorded in the years leading up to the events. This design can identify differences in observed trajectories, but it does not by itself establish cause and effect.

The researchers assessed more than one dimension of function. Frailty was measured using both the Frailty Index and Fried phenotype; intrinsic capacity and physical health-related quality of life were also included. Looking across these measures allowed the team to describe a broader pattern than any single marker could provide. The report does not give detailed participant characteristics or explain how well the findings might apply to people outside this cohort.

“Declines in functional aging markers were prominent before clinically apparent CVD.”

— Aung Zaw Zaw Phyo and colleagues, writing in JAMA Cardiology

Limits of Prediction and Causation

The findings show an association between later cardiovascular events and earlier functional decline, but they do not establish that decline causes cardiovascular disease. Nor do they show whether a particular clinical response, such as more frequent assessments or an intervention, would reduce events. The report does not provide a validated method for using these measures to predict risk for an individual.

Further details also remain unclear from the available account, including how the results varied across participant characteristics and how well they generalize beyond this cohort. The study’s timing findings distinguish heart failure and fatal coronary heart disease from myocardial infarction and stroke, but the report does not explain why those patterns differed. These results should not be used as medical advice or as a diagnosis; personal cardiovascular concerns should be discussed with a qualified health professional.

Testing Clinical Use in Future Studies

The study was published online in JAMA Cardiology on September 23, 2026. The supplied report does not identify a planned follow-up study, a clinical guideline change or a specific next milestone. Further research would be needed to determine whether tracking functional aging measures improves cardiovascular risk assessment and whether acting on changes can improve health outcomes.

Until that evidence is available, the reported trajectories are best understood as a finding about differences between groups over time—not a screening rule. Researchers and clinicians would need to establish which measures are useful, how they should be interpreted and whether they add actionable information to existing assessments.

Key Questions

What did the study find?

People who later experienced cardiovascular events had worse frailty, intrinsic capacity and physical health-related quality of life than matched controls, with differences observed up to a decade beforehand and widening in the five years before events.

How many people were included?

The analysis included 12,015 participants: 2,403 who experienced a cardiovascular event and 9,612 matched controls from the Aspirin in Reducing Events in the Elderly cohort.

Does functional decline cause cardiovascular disease?

The study does not show that it does. It reports an association and differences in trajectories; an observational analysis cannot establish that functional decline causes a later cardiovascular event.

Can these measures predict an individual’s heart event?

The report does not establish an individual prediction tool, risk threshold or screening rule. The findings describe patterns across groups, and further research is needed to determine clinical use.

Which events showed earlier differences?

The report says divergence appeared at least 10 years before heart failure and fatal coronary heart disease. For myocardial infarction and stroke, the differences emerged later, though the supplied account does not specify the exact timing.

Source: rss