Functional Decline Precedes Cardiovascular Disease Events By Many Years

TL;DR

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A study published in JAMA Cardiology found that participants who later experienced cardiovascular disease events had worse measures of frailty, intrinsic capacity and physical health than matched controls up to a decade beforehand. The differences widened in the five years before events, but the observational findings do not show that functional decline causes cardiovascular disease or establish a screening strategy.

A study of 12,015 participants found that worsening frailty and physical functioning were apparent years before cardiovascular disease events, and that differences from matched controls grew markedly in the five years before an event. Published online September 23 in JAMA Cardiology, the analysis suggests a prolonged period in which clinicians may be able to evaluate changes in older adults, but it does not establish that functional decline causes heart disease or that a particular intervention prevents it.

Aung Zaw Zaw Phyo of Monash University in Melbourne and colleagues examined participants in the Aspirin in Reducing Events in the Elderly cohort. The analysis compared 2,403 people who experienced a cardiovascular event with 9,612 matched controls. Researchers tracked functional performance and aging measures in the years before the events.

Compared with controls, people who later had an event showed consistently higher frailty, lower intrinsic capacity and poorer physical health-related quality of life, with differences visible up to a decade beforehand. The researchers reported that these gaps widened substantially during the five years before an event, as the event group’s measures deteriorated faster.

Over time, the event group had greater increases in frailty measured by both the Frailty Index and Fried phenotype, and steeper declines in intrinsic capacity and physical health-related quality of life. Similar patterns appeared across cardiovascular event types, but the timing differed: divergence was reported at least 10 years before heart failure and fatal coronary heart disease, while the source does not report the same early timing for heart attack or stroke.

A Longer Window for Clinical Evaluation

The findings matter because cardiovascular risk is often considered through measures such as blood pressure, cholesterol and diagnosed conditions, while changes in frailty and everyday physical capacity may offer additional information about a person’s health trajectory. If the patterns are confirmed in further research, monitoring functional changes could help clinicians identify people whose broader health is worsening before a major cardiovascular event becomes apparent.

The study authors describe the years before an event as a potential window for closer clinical evaluation and early intervention. That is an interpretation of the observed trajectories, not evidence that screening based on these measures improves outcomes. The report does not identify a specific test, treatment or action that readers should pursue on the basis of the findings alone.

How Researchers Tracked Aging Before Events

The study was a nested case-control analysis within the Aspirin in Reducing Events in the Elderly cohort. Researchers compared participants who experienced a cardiovascular event with matched participants who did not, examining changes in multiple measures rather than relying on a single indicator of aging or physical health.

The measures included frailty, intrinsic capacity and physical health-related quality of life. The paper, titled “Multidimensional Aging Trajectories Preceding Cardiovascular Events,” was published in JAMA Cardiology in 2026. Medical Xpress reported the results on October 1, citing the journal publication. The source report describes associations over time; it does not say that the analysis tested whether functional decline itself triggers cardiovascular disease.

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

— Aung Zaw Zaw Phyo and colleagues, the study authors

What the Study Cannot Establish

The reported analysis shows that functional measures and later cardiovascular events were associated; it does not show that frailty or declining capacity caused the events. The source report also does not specify which functional measure would be most useful for predicting an individual’s risk, how accurately it could identify future events, or whether acting on such measurements would reduce heart attacks, strokes, heart failure or deaths.

The available report gives no detailed breakdown of participant demographics, the full event counts by cardiovascular condition, or the effects of particular treatments and health conditions on the observed trajectories. It also does not provide enough information to determine how well the results apply beyond the study cohort. The findings should not be read as personal medical advice or as a reason to change care without consulting a qualified health professional.

Further Evidence Needed for Clinical Use

The immediate next step is additional research testing whether these trajectories appear in other populations and whether functional measures add useful predictive information to established cardiovascular assessments. Researchers would also need to determine whether structured evaluation of declining function leads to changes in care that improve patient outcomes.

The source report does not announce a follow-up study, trial or clinical guideline change. For now, the findings are a research signal about when functional decline may become visible in people who later experience cardiovascular events, rather than a new screening recommendation. Patients with concerns about changes in their health or physical abilities should discuss them with a qualified clinician.

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 present years before the event and widening in the last five years.

How many people were included?

The analysis included 12,015 participants: 2,403 who experienced a cardiovascular event and 9,612 matched controls.

Does the study prove functional decline causes heart disease?

No. The analysis found patterns that preceded cardiovascular events, but the reported findings do not establish that functional decline causes those events.

Does this change what patients should do?

The report does not set out a new screening or treatment recommendation. People should discuss health concerns or changes in physical function with a qualified health professional, rather than making care decisions based on this study alone.

Source: rss