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A JAMA Cardiology study found that older adults who later experienced cardiovascular disease events had worse frailty, intrinsic capacity and physical health-related quality of life than matched controls up to a decade earlier. Differences widened in the five years before events, but the study does not show that functional decline causes cardiovascular disease or that screening for it prevents events.
Older adults who later experienced cardiovascular disease (CVD) events already had worse measures of frailty, physical function and health-related quality of life up to 10 years beforehand, according to a study published online Sept. 23 in JAMA Cardiology. The findings suggest that changes in functional aging may provide a long period in which clinicians could evaluate patients more closely, but they do not establish that those changes cause heart disease or that acting on them would prevent an event.
The nested case-control analysis included 12,015 participants from the Aspirin in Reducing Events in the Elderly cohort: 2,403 people who experienced a CVD event and 9,612 matched controls. Aung Zaw Zaw Phyo of Monash University in Melbourne, Australia, and colleagues examined how functional-performance measures changed in the years before an event.
Compared with controls, participants who later had an event showed higher frailty, lower intrinsic capacity and poorer physical health-related quality of life. These differences were present as far as a decade before the event and widened markedly during the five preceding years, the study report said.
Over time, the event group had faster deterioration on the measures reported by the researchers: the Frailty Index and Fried frailty phenotype rose more, while intrinsic capacity and physical health-related quality-of-life scores declined more. Similar broad patterns appeared across CVD event types, but their timing varied: differences emerged at least 10 years beforehand for heart failure and fatal coronary heart disease, while divergence occurred later for myocardial infarction and stroke.
A Longer Window for Clinical Attention
The results may matter because they point to functional changes that can precede a clinically apparent CVD event by years, rather than appearing only around diagnosis. If these measures are confirmed as useful in clinical settings, they could help clinicians identify older patients whose overall health or functional status merits closer evaluation. The authors describe the pattern as a possible prolonged window for clinical evaluation and early intervention.
That is a potential implication, not a tested prevention strategy. The study tracked measures and later events; it did not test whether screening for frailty or changes in physical capacity, or intervening on those measures, reduces heart attacks, strokes, heart failure or deaths. The findings also do not mean that functional decline is a specific warning sign of CVD in an individual. Such changes can reflect multiple aspects of aging and health.
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How the Study Tracked Aging
The report, titled “Multidimensional Aging Trajectories Preceding Cardiovascular Events,” was published in JAMA Cardiology in 2026. Its authors used data from the Aspirin in Reducing Events in the Elderly cohort, comparing people who experienced CVD events with matched participants who did not experience an event during the relevant comparison.
The analysis focused on several dimensions of functional aging rather than on a single test. These included two frailty measures, intrinsic capacity and physical health-related quality of life. Considering these measures together allowed the researchers to describe how multiple aspects of function changed over time. The study is an observational analysis of existing cohort data, so it can show patterns and timing but cannot by itself establish why the differences developed.
“Declines in functional aging markers were prominent before clinically apparent CVD.”
— Aung Zaw Zaw Phyo and colleagues, study authors
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Limits of the Event Timeline
The reported results do not show whether declining function contributed to later CVD, resulted from early or developing disease, or reflected other health changes that occurred alongside it. Because the study was observational, it cannot settle cause and effect. The source report also does not provide enough detail to determine how well these measures predict an event for an individual, or whether adding them to existing clinical assessments would improve prediction.
The analysis involved participants in a particular older-adult cohort, and the report does not establish that the same timelines apply to younger people or other populations. It also does not specify what form of clinical evaluation or early intervention would be most effective. The differences by event type—including earlier divergence for heart failure and fatal coronary heart disease—are reported patterns, not proof that the measures can distinguish which event a person may later experience.
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Testing Clinical Use in Practice
The study provides evidence for a long-term association, but practical use would require further research. Future studies could examine whether functional-aging measures improve CVD risk assessment beyond established clinical information, whether the observed patterns hold in other populations, and which responses to a concerning decline are helpful.
For now, the findings support attention to functional health as part of the broader picture of older adults’ health, not a standalone prediction or diagnosis of cardiovascular disease. The report does not announce a follow-up trial or a change to clinical guidelines; what clinicians should do specifically in response to these measures remains unsettled.
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Key Questions
How far ahead of a cardiovascular event were differences observed?
The study reported worse functional-aging profiles among people who later had CVD events up to a decade beforehand. Differences widened in the five years before an event.
Which measures differed between the groups?
The event group had higher frailty, lower intrinsic capacity and poorer physical health-related quality of life than matched controls. The analysis used the Frailty Index and Fried frailty phenotype as frailty measures.
Does functional decline cause cardiovascular disease?
The study does not establish that. It found an association and a timeline in cohort data, but an observational analysis cannot show whether functional decline causes CVD, reflects developing disease or relates to other health factors.
Can these findings predict an individual’s heart attack or stroke?
That has not been established by the report. It describes group-level differences before events, not a validated individual prediction tool, and it does not show that the measures identify which type of CVD event may occur.
Did the study test whether early intervention prevents events?
No. The authors suggest a possible window for closer clinical evaluation and early intervention, but the study did not test whether screening or any specific intervention prevents cardiovascular events.
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