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A study of 12,015 older adults found that people who later experienced cardiovascular disease events had worse functional-aging measures as far as a decade beforehand. Differences 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 published online Sept. 23 in JAMA Cardiology found that older adults who later experienced a cardiovascular event had worse measures of frailty, intrinsic capacity and physical health-related quality of life than matched peers as far as a decade beforehand. The differences grew in the five years before an event, suggesting a long period in which functional changes might merit clinical attention, though the study does not show that decline causes cardiovascular disease.
Researchers led by Aung Zaw Zaw Phyo of Monash University examined data from 12,015 participants in the Aspirin in Reducing Events in the Elderly cohort. The analysis included 2,403 people who experienced a cardiovascular event and 9,612 matched controls. The team compared changes in functional-aging measures over time before the event.
People in the event group had consistently worse functional profiles than controls, including greater frailty, lower intrinsic capacity and poorer physical health-related quality of life. In the five years before an event, the gap widened markedly. The researchers reported faster increases in frailty and steeper declines in intrinsic capacity and physical quality-of-life scores among those who later had an event.
The pattern was broadly similar across components of the cardiovascular-disease composite, but its timing varied. Differences appeared at least 10 years before heart failure and fatal coronary heart disease; for myocardial infarction and stroke, the divergence was not reported as occurring as early. The study was published as “Multidimensional Aging Trajectories Preceding Cardiovascular Events,” with DOI 10.1001/jamacardio.2026.3597.
A Longer Window for Clinical Attention
The findings suggest that cardiovascular risk may be accompanied by changes in physical function and broader health well before an event becomes clinically apparent. If clinicians see declining function over time, that information could contribute to a fuller assessment alongside established cardiovascular risk factors. The study authors describe the pattern as a possible prolonged opportunity for closer evaluation and early intervention.
That implication is not the same as showing that measuring frailty will prevent heart attacks or strokes. The analysis tracked associations before events; it did not test whether acting on functional measures changes outcomes. It also does not establish that functional decline is a specific warning sign, since declining capacity can reflect many aspects of aging and health. Readers should not treat the findings as an individual prediction or a substitute for medical assessment.
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How Researchers Tracked Decline
The report is based on a nested case-control analysis within the Aspirin in Reducing Events in the Elderly cohort. Researchers compared participants who experienced cardiovascular events with matched participants who did not, examining functional measures in the years leading up to the event. That design can identify patterns over time but, by itself, cannot determine cause and effect.
The study assessed several dimensions rather than relying on one measure: frailty, intrinsic capacity and physical health-related quality of life. The authors described functional decline as potentially reflecting progressive, multisystem aging. Their report appeared in JAMA Cardiology online on Sept. 23, 2026, and Medical Xpress summarized it in an article dated Oct. 1.
““Declines in functional aging markers were prominent before clinically apparent CVD.””
— The study authors
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Limits of the Findings
The report describes associations, not proof that functional decline causes cardiovascular disease or that it can reliably predict an event in an individual. The available summary does not provide enough detail to establish how well the measures distinguish people who will experience an event from those who will not, or whether using them in routine care improves outcomes. It also does not specify here the full participant age range, event counts by category, or how results might apply beyond this cohort.
The findings are drawn from the Aspirin in Reducing Events in the Elderly cohort; they should not automatically be generalized to younger populations or other settings. The reported timing differences among heart failure, fatal coronary heart disease, myocardial infarction and stroke also leave open why trajectories diverged earlier for some outcomes than others.
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From Association to Care Decisions
The next question is whether functional-aging measures can add useful information to established cardiovascular assessments and whether responding to changes improves health outcomes. This report does not announce a clinical guideline or a tested screening program. Further research would need to evaluate predictive value, generalizability and the effects of intervention before the findings could support specific care recommendations.
For now, the study offers evidence that declining function can precede some cardiovascular events by years, not a new diagnostic rule. People concerned about changes in their physical capacity should discuss them with a health professional, who can assess them in light of individual symptoms and risk factors.
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Key Questions
What did the study find?
Among 12,015 cohort participants, those who later experienced a cardiovascular event had worse frailty, intrinsic-capacity and physical quality-of-life measures than matched controls, with gaps widening before the event.
How long before an event did differences appear?
The study reported worse profiles as far as a decade before cardiovascular events. Differences 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 functional decline cause cardiovascular disease?
The study does not establish cause and effect. It found an association between earlier functional decline and later events in an observational analysis.
Does this mean functional measures should be used as a screening test?
Not on the basis of this report alone. It did not test a screening approach or show that using these measures changes outcomes; their predictive value and clinical usefulness remain to be established.
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