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A JAMA Cardiology study found that people who later had cardiovascular disease events showed worse frailty, intrinsic capacity and physical health years beforehand than matched controls. The gaps widened in the five years before events, but the observational findings do not show that functional decline causes cardiovascular disease or establish a screening approach.
Functional aging measures worsened years before cardiovascular events in a study of 12,015 older adults, with gaps in frailty, physical capacity and health-related quality of life widening markedly in the five years before events. Published online Sept. 23 in JAMA Cardiology, the analysis points to a possible period for closer clinical evaluation, but does not show that functional decline causes cardiovascular disease.
Researchers led by Aung Zaw Zaw Phyo of Monash University in Melbourne analyzed participants in the Aspirin in Reducing Events in the Elderly cohort. The nested case-control study compared 2,403 people who experienced a cardiovascular event with 9,612 matched controls. It examined changes in functional aging measures in the years before an event.
Across the period studied, the group that later had an event had higher frailty, lower intrinsic capacity and poorer physical health-related quality of life than controls. In the five years before an event, those differences grew. The researchers reported faster increases in frailty and steeper declines in intrinsic capacity and physical quality-of-life scores among cases.
The pattern appeared across components of the cardiovascular disease composite, but its timing varied. Differences emerged at least 10 years before heart failure and fatal coronary heart disease; for myocardial infarction and stroke, the report says divergence occurred later. The source does not provide enough detail to translate the reported statistical coefficients into a change that would be readily interpretable for an individual patient.
A Longer Window for Clinical Attention
The findings suggest that cardiovascular events may be preceded by gradual changes in health and physical function, rather than appearing against an otherwise stable functional profile. If replicated and assessed in clinical settings, such patterns could help clinicians consider broader health changes when evaluating older adults—not just conventional cardiovascular risk factors.
The authors describe the period before an event as a potential window for closer evaluation and early intervention. That is an implication, not a tested intervention: the study did not establish that monitoring these measures prevents heart attacks, strokes or heart failure. Nor does it show that a decline in function is a specific warning sign for cardiovascular disease, since functional measures can reflect many aspects of aging and health.
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How Researchers Tracked Aging Measures
The analysis used data from the Aspirin in Reducing Events in the Elderly cohort and compared trajectories for participants who did and did not experience cardiovascular events. The matched-control design let researchers examine how several measures differed in the years leading up to an event, rather than looking only at a single assessment near diagnosis.
The study, titled Multidimensional Aging Trajectories Preceding Cardiovascular Events, was published in JAMA Cardiology in 2026. Its focus was functional aging: frailty, intrinsic capacity and physical health-related quality of life. These are related but distinct measures, and the report does not describe them as diagnostic tests for cardiovascular disease.
“Declines in functional aging markers were prominent before clinically apparent CVD.”
— The study authors
What the Study Cannot Establish
The findings show an association between worsening functional measures and later cardiovascular events. They do not establish that functional decline causes those events, or that the measures can predict which individual will have one. The report also does not specify a validated threshold that clinicians could use to trigger testing or treatment.
The supplied summary does not provide details such as participants’ average age, the length of follow-up, the full list of cardiovascular event definitions, or adjustments made for other health differences. It also does not report whether the observed patterns apply to people outside this cohort. Further research would be needed to determine how useful these measures are for risk assessment and whether acting on them improves health outcomes.
Testing the Findings in Practice
The next step is to see whether the patterns hold in other populations and whether functional measures add useful information to established cardiovascular risk assessments. Researchers would also need to test specific clinical approaches—such as when to evaluate a change in frailty or physical capacity—and measure whether those approaches affect event rates or quality of life.
For now, the study supports attention to the reported long-term association, but it does not announce a new screening recommendation. The authors’ call for closer evaluation should be read as a proposed implication of the findings, not guidance to change care independently of a 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 years beforehand. Differences widened in the five years before events.
Does functional decline cause cardiovascular disease?
The study does not establish cause and effect. It found an association between changes in functional measures and later cardiovascular events.
Which events showed earlier differences?
The report says differences appeared at least 10 years before heart failure and fatal coronary heart disease. For myocardial infarction and stroke, divergence occurred later.
Does this study recommend screening for frailty?
No screening recommendation is reported. The authors suggest closer clinical evaluation may be worth considering, but the study did not test a screening program or show that it prevents events.
Who was included in the analysis?
The analysis included 12,015 participants from the Aspirin in Reducing Events in the Elderly cohort: 2,403 who experienced a cardiovascular event and 9,612 matched controls.
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