Functional Decline Precedes Cardiovascular Disease Events By Many Years

TL;DR

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A study published online in JAMA Cardiology found that people 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 beforehand. Differences widened in the five years before an event, but the observational findings do not establish that functional decline causes cardiovascular disease or that a particular intervention prevents it.

A study published online September 23 in JAMA Cardiology found that older adults who later experienced cardiovascular disease events showed worse frailty, physical function and quality of life than matched peers as far as a decade beforehand. The results point to a long period in which functional differences may be apparent before a clinically recognized event, but do not show that those changes cause heart disease or that a specific intervention would prevent it.

Researchers led by Aung Zaw Zaw Phyo of Monash University analyzed data from 12,015 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. The report describes the work as a nested case-control study.

Across the years before an event, the cases had higher frailty, lower intrinsic capacity and poorer physical health-related quality of life than controls. The gaps widened markedly during the five years before the event. The researchers reported faster increases in frailty and steeper declines in intrinsic capacity and physical quality of life among those who later had an event.

Patterns were broadly similar across components of the cardiovascular disease composite, but the timing differed. The study reported that divergence appeared at least 10 years beforehand for heart failure and fatal coronary heart disease, while differences preceding myocardial infarction or stroke emerged later. These are group-level patterns; the report does not establish that functional measures can predict which individual will have an event.

A Longer Window for Clinical Attention

The findings add a long-term view to cardiovascular risk: changes in frailty and physical function may accompany the years leading up to an event, rather than appearing only close to diagnosis. If future work confirms the pattern and identifies useful ways to act on it, clinicians may have a longer period to review a patient’s health and consider appropriate evaluation.

The authors said the observed trajectories may reflect progressive changes across multiple body systems and could indicate an extended opportunity for closer clinical evaluation and early intervention. That is an interpretation of the study, not proof that functional decline is a cause of cardiovascular disease or that reversing it will prevent an event. The findings also do not justify using frailty measures alone to diagnose heart disease or estimate an individual’s risk.

For readers, the distinction matters: a population-level association is not an individual forecast. The report describes differences between groups over time, but does not provide a clinical threshold, screening recommendation or tested intervention based on these measures. People making health decisions should discuss symptoms and concerns with a qualified health professional.

How Researchers Tracked Function Over Time

The study used participants in the Aspirin in Reducing Events in the Elderly cohort and compared people who experienced cardiovascular events with matched controls. Rather than examining measurements only at the time of an event, the researchers assessed trajectories across the preceding years. They considered several indicators: frailty, intrinsic capacity and physical health-related quality of life.

The paper, titled “Multidimensional Aging Trajectories Preceding Cardiovascular Events,” was published in JAMA Cardiology on September 23, 2026. Medical Xpress reported the results on October 1. The available report summarizes associations over time; it does not describe a trial in which participants were assigned a treatment to test whether changing functional status affects cardiovascular outcomes.

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

— Aung Zaw Zaw Phyo and colleagues, authors of the JAMA Cardiology study

Prediction and Prevention Remain Untested

The reported results show associations between functional trajectories and later events, but do not establish cause and effect. The study summary does not show whether changes in frailty or physical function independently predict events after accounting for all relevant health factors, or how accurately these measures would classify individual patients.

It also remains unclear what specific clinical assessment or intervention should follow from the findings. The study did not test whether monitoring functional decline, treating it, or changing cardiovascular care on that basis reduces heart attacks, strokes, heart failure or deaths. The results concern participants in one named cohort; the available report does not establish how well the patterns apply to other age groups or populations.

Testing Clinical Use in Future Studies

The next step is for further research to determine whether functional measures add useful information to existing cardiovascular assessments and whether any approach based on them improves outcomes. Such studies would need to test specific screening or care strategies, rather than infer benefit from the timing of group differences alone.

Until that evidence is available, the report supports attention to the observed long-term association, not a new stand-alone prediction tool. The study’s published findings and subsequent research will clarify whether the apparent window before events can be used to guide clinical decisions.

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. The differences 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 the study show that functional decline causes heart disease?

No. The report describes an association over time. It does not establish that functional decline causes cardiovascular disease or that changing functional status prevents an event.

Can these measures predict an event for an individual?

The report gives group-level findings, not a validated individual prediction method. It does not provide a clinical cutoff or show how accurately the measures identify who will experience an event.

When were differences seen before specific events?

The report says differences emerged at least 10 years before heart failure and fatal coronary heart disease. For myocardial infarction and stroke, divergence appeared later; the supplied report does not give a more precise timeframe.

Source: rss