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A study published in JAMA Cardiology found that people who later experienced cardiovascular events had poorer functional health than matched controls as far as a decade beforehand. Differences widened in the five years before an event, though the observational findings do not show that functional decline causes cardiovascular disease or establish a screening approach.
Older adults who later experienced cardiovascular events had poorer functional health than matched peers up to 10 years before the events, according to a study published online September 23 in JAMA Cardiology. Differences in frailty and physical capacity widened as events approached in an analysis of 12,015 participants. The findings do not establish that functional changes cause cardiovascular disease or identify a proven screening method.
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 analysis included 2,403 people who experienced a cardiovascular event and 9,612 matched controls. Researchers compared measures of functional aging over the years before an event.
Those who later had an event showed higher frailty, lower intrinsic capacity and poorer physical health-related quality of life than controls, with differences visible up to 10 years before the event. In the five years immediately preceding an event, the gap widened markedly. The researchers also reported faster increases in frailty and steeper declines in intrinsic capacity and physical quality of life among the event group.
The broad pattern appeared across cardiovascular event types, but timing differed. The authors reported that functional profiles diverged at least a decade ahead of heart failure and fatal coronary heart disease; for myocardial infarction and stroke, the separation emerged later. The report does not provide evidence that measuring these markers would prevent events.
A Longer Window for Clinical Attention
The findings matter because cardiovascular risk is often discussed in terms of established risk factors and tests, while changes in everyday function may accumulate well before a diagnosis or acute event. If the pattern is replicated and made clinically useful, tracking frailty, physical capacity and quality of life could help clinicians recognize people whose overall health is worsening and consider whether further evaluation is appropriate.
That is a possibility, not a recommendation established by this study. The analysis shows an association between declining functional measures and later events; it does not prove that functional decline is an early warning tool for an individual, nor that intervening on those measures will prevent a heart attack, stroke or heart failure. The results should not be used by readers to diagnose cardiovascular disease or change care without a qualified health professional.
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How Researchers Tracked Functional Aging
The study, titled Multidimensional Aging Trajectories Preceding Cardiovascular Events, used data from the Aspirin in Reducing Events in the Elderly cohort. Its matched case-control design compared participants who experienced a cardiovascular event with participants selected as controls, looking backward at changes in several dimensions of health rather than focusing on a single measurement.
The measures included two frailty assessments, intrinsic capacity and physical health-related quality of life. The published report describes increasingly unfavorable trajectories among cases and says the differences were particularly pronounced during the final five years before an event. Because the analysis is based on people who did and did not experience events, it can identify patterns in the data but cannot by itself determine cause and effect.
“Declines in functional aging markers were prominent before clinically apparent CVD.”
— Aung Zaw Zaw Phyo and colleagues, the study authors
Limits of the Early-Warning Evidence
The findings do not show whether declining function directly contributes to cardiovascular disease, results from early or unrecognized disease, or reflects other health changes. The study also does not establish how accurately these measures predict an event for an individual, what thresholds clinicians should use, or whether adding them to existing risk assessments improves outcomes.
The supplied report does not give detailed information about participant demographics, the full follow-up schedule or the absolute event risks associated with each measure. It is also unclear whether the same trajectories would appear in populations with different ages or health profiles. The reported timing describes group-level differences, not a reliable countdown to an event for any one person.
Replication and Clinical Testing
The study authors point to closer clinical evaluation and early intervention as areas for consideration, but the report does not announce a specific follow-up trial or change in clinical guidance. Further research would need to test whether functional measures improve prediction beyond established cardiovascular assessments and whether acting on those findings changes health outcomes.
For now, the results add evidence that functional aging and cardiovascular events can follow related long-term trajectories. Whether routine tracking of these measures should become part of cardiovascular care remains unsettled; readers with concerns about declining function or heart health should discuss them with a qualified health professional.
Key Questions
What did the study find?
People who later experienced cardiovascular events had higher frailty and poorer functional health than matched controls, with differences evident years before an event and widening during the final five years.
How many people were included?
The analysis included 12,015 participants: 2,403 who experienced a cardiovascular event and 9,612 matched controls 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 an association between worsening functional measures and later events, but cannot determine whether decline contributes to disease, reflects early disease, or relates to other factors.
Can these findings predict an event for an individual?
Not on their own, based on the reported evidence. The analysis describes patterns across groups and does not establish an individual prediction tool, clinical threshold or screening recommendation.
When did functional differences appear?
Differences were reported up to a decade before cardiovascular events. They appeared earlier for heart failure and fatal coronary heart disease than for myocardial infarction or stroke, according to the study report.
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