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A study published in JAMA Cardiology found that people who later experienced cardiovascular disease events had worse frailty, intrinsic capacity and physical quality-of-life profiles than matched controls as far as a decade beforehand. 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 strategy.
A study of 12,015 older adults found that people who later experienced a cardiovascular disease event had worse measures of frailty, physical capacity and physical health-related quality of life than matched peers as far as 10 years before the event. Published online Sept. 23 in JAMA Cardiology, the analysis found that these differences widened in the five years before an event, pointing to a long period in which functional changes could be relevant to clinical evaluation.
Aung Zaw Zaw Phyo of Monash University in Melbourne and colleagues analyzed participants in the Aspirin in Reducing Events in the Elderly cohort. The nested case-control study compared 2,403 participants who experienced a cardiovascular event with 9,612 matched controls. Researchers examined how functional measures changed in the years leading up to an event.
Compared with controls, participants who later had an event consistently showed higher frailty, lower intrinsic capacity and poorer physical health-related quality of life. In the five years before an event, the groups’ profiles diverged more markedly. The researchers reported faster increases in frailty and steeper declines in intrinsic capacity and physical quality of life among cases.
Patterns were broadly similar across the components of the cardiovascular-disease composite, but the timing varied. Differences appeared at least a decade before heart failure and fatal coronary heart disease, while divergence for myocardial infarction and stroke was not reported as beginning as early. The study describes patterns before events; it does not establish that functional decline causes them.
A Longer Window for Clinical Attention
The findings may matter because cardiovascular risk can be discussed in terms of more than a single measurement or a sudden event. A gradual worsening in frailty and physical function could provide clinicians with another signal to review a patient’s overall health, alongside established cardiovascular assessments. The study authors say the patterns suggest a prolonged opportunity for closer evaluation and early intervention.
That is a possible implication, not a tested care recommendation. The analysis did not evaluate whether tracking these measures, changing treatment in response, or intervening earlier prevents heart attacks, strokes or other cardiovascular outcomes. Nor does it show that a person experiencing functional decline will go on to have an event. The findings identify an association across groups, not a tool for predicting an individual’s risk.
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How Researchers Tracked Decline
The report, published online on September 23, 2026, is based on a nested case-control analysis within the Aspirin in Reducing Events in the Elderly cohort. Researchers compared participants who had cardiovascular events with matched controls and assessed functional-aging measures over time before the event. The study was published in JAMA Cardiology as “Multidimensional Aging Trajectories Preceding Cardiovascular Events.”
Its measures covered several aspects of health rather than one definition of functional decline. The analysis included two frailty measures, intrinsic capacity and physical health-related quality of life. The report gives statistical estimates for changes over time, but those values describe the study’s modeled trajectories; they should not be read as an individual’s expected change or as a clinical threshold.
““Declines in functional aging markers were prominent before clinically apparent CVD.””
— Aung Zaw Zaw Phyo and colleagues, study authors
Limits on Prediction and Prevention
The study does not establish why functional decline and cardiovascular events are associated, whether one contributes to the other, or whether both reflect other health processes. It also does not show that acting on the measures would prevent events. The supplied report does not specify enough detail to assess how well these trajectories could predict an individual’s risk in routine care.
Further questions include whether the patterns apply to populations beyond the cohort, how differences vary among participants, and what level of change should prompt clinical action. The findings concern changes observed before events and cannot diagnose cardiovascular disease. People should not interpret declining function alone as proof that a cardiovascular event is imminent.
Testing Use in Clinical Care
The report identifies a potential direction for further research: testing whether repeated functional assessments can improve cardiovascular risk evaluation and whether care guided by those assessments changes outcomes. Until such work establishes their value, the results do not set new screening rules or treatment guidance. Clinicians will need evidence on the measures’ predictive accuracy, practical use and benefit before they can be adopted as a routine approach.
The immediate takeaway is limited but relevant: in this cohort, signs of poorer function were present years before cardiovascular events and grew more pronounced near the event. Whether monitoring those changes can help people avoid an event remains unanswered.
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 profiles than matched controls, with differences visible as far as a decade beforehand.
Does functional decline cause cardiovascular disease?
No causal link was established. The study found an association between functional-aging trajectories and later events; it did not determine whether decline causes cardiovascular disease or results from other factors.
Which events showed earlier differences?
The report says divergence appeared at least 10 years before heart failure and fatal coronary heart disease. The timing was not as early for myocardial infarction or stroke.
Does the study recommend a new screening test?
No. The authors suggest the findings may support closer clinical evaluation, but the study did not test a screening program or show that monitoring these measures prevents cardiovascular events.
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