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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 measures than matched controls as far as a decade earlier. The differences widened in the five years before an event, but the observational findings do not establish that functional decline causes cardiovascular disease or show that screening prevents events.
People who experienced a cardiovascular disease event had worse measures of frailty, physical capacity and health-related quality of life than matched controls years beforehand, according to a study published online Sept. 23 in JAMA Cardiology. The analysis of 12,015 participants found that the differences widened markedly in the five years before an event, suggesting functional measures could help identify a period for closer clinical evaluation; it did not establish that decline causes heart disease.
Aung Zaw Zaw Phyo of Monash University in Melbourne and colleagues analyzed data from the Aspirin in Reducing Events in the Elderly cohort. The sample included 2,403 people who experienced a cardiovascular event and 9,612 matched controls. The researchers compared functional-aging measures over time before the event, including frailty, intrinsic capacity and physical health-related quality of life.
Across the years studied, the eventual cases had consistently worse profiles than controls, with differences evident up to a decade before an event. In the five years beforehand, the gap widened markedly. The report says cases experienced faster increases in frailty and steeper declines in intrinsic capacity and physical quality of life. The reported trajectory estimates included β = 0.78 for the Frailty Index, β = 0.05 for the Fried frailty phenotype, β = −0.34 for intrinsic capacity and β = −0.55 for physical health-related quality of life.
The pattern appeared across components of the cardiovascular composite, but the timing varied. Differences emerged at least 10 years before heart failure and fatal coronary heart disease; for myocardial infarction and stroke, the report does not give an equivalent early divergence point. The study, titled “Multidimensional Aging Trajectories Preceding Cardiovascular Events,” was published in JAMA Cardiology in 2026.
Functional Changes May Offer Earlier Warning
The findings matter because they point to a long period in which changes in a person’s overall function may accompany the development of cardiovascular disease, before a clinically apparent event. If further research confirms the pattern and establishes useful ways to assess it, functional measures could complement existing clinical evaluation and help clinicians recognize patients whose health is changing.
That possibility is not the same as a proven screening strategy. The study reports associations between earlier functional decline and later events; it does not show that monitoring these measures, or acting on them, reduces heart attacks, strokes, heart failure or deaths. The results also do not mean that an individual with frailty or reduced physical capacity will necessarily develop cardiovascular disease. Medical decisions should be made with a qualified health professional.
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How Researchers Tracked Aging Before Events
The analysis was a nested case-control study using participants in an existing cohort, rather than a trial testing a new intervention. Researchers compared people who went on to have a cardiovascular event with matched participants who served as controls, then examined how several functional-aging measures changed in the preceding years.
Those measures capture different aspects of health: frailty scores reflect vulnerability, intrinsic capacity describes a person’s overall physical and mental abilities, and physical health-related quality of life records perceived physical wellbeing. Looking at these indicators together allowed the researchers to describe a broader pattern than a single measure could show. The work was published online Sept. 23, with the report on the findings dated Oct. 1, 2026.
““Declines in functional aging markers were prominent before clinically apparent CVD.””
— Aung Zaw Zaw Phyo and colleagues, as quoted in the study report
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Association Does Not Prove Cause
The report does not show that functional decline causes cardiovascular disease, or that preventing decline would prevent an event. Because the analysis compared trajectories in an observational cohort, it cannot by itself determine whether declining function is an early sign of disease, a consequence of other health changes, or related to shared factors. The supplied report also does not specify the participants’ average age, the number of each event type, or the full adjustment methods, limiting what can be concluded from the summary alone.
It is also unclear whether these measures would reliably predict risk for an individual in routine care, what thresholds clinicians might use, or whether acting on a change would improve outcomes. The results describe group-level differences and should not be treated as a diagnosis or a personal forecast.
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Further Work Must Test Clinical Use
The study authors say the pattern supports closer clinical evaluation and early intervention as possibilities for the extended period before an event. The report does not announce a specific follow-up trial, screening program or change to clinical guidance. Further studies would need to test whether adding functional-aging measures to standard care improves risk identification and whether interventions based on those results change cardiovascular outcomes.
For now, the findings are evidence of a long-term association in this cohort, not a new stand-alone test. Readers with concerns about changes in their health or physical function should discuss them with a qualified health professional, who can assess them alongside other individual risk factors.
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Key Questions
What did the study find?
People who later experienced cardiovascular events had worse measures of frailty, intrinsic capacity and physical quality of life than matched controls, with differences reported up to a decade beforehand. The gaps widened in the five years before an event.
How many people were included?
The analysis included 12,015 participants: 2,403 people who experienced a cardiovascular event and 9,612 matched controls, drawn from the Aspirin in Reducing Events in the Elderly cohort.
Does functional decline cause cardiovascular disease?
The study does not establish cause and effect. It found that functional decline and later cardiovascular events were associated in the analyzed cohort; it did not show that one caused the other.
Does this mean functional measures can predict an individual’s heart event?
Not on the evidence reported. The study describes group-level trajectories, but the report does not establish a clinical threshold or show how accurately these measures predict an individual’s risk.
When did the differences appear?
The researchers reported worse profiles up to a decade before cardiovascular events overall. For heart failure and fatal coronary heart disease, divergence was seen at least 10 years before the event; the timing differed for myocardial infarction and stroke.
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