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A study in JAMA Cardiology found that people who later had cardiovascular events showed poorer functional health than matched controls as far as a decade beforehand. Differences widened in the five years before an event, but the observational findings do not show that functional decline causes cardiovascular disease or establish a screening strategy.
A study of 12,015 participants found that people who later experienced a cardiovascular disease event had worse measures of frailty, physical capacity and physical health-related quality of life than matched controls, with differences apparent up to a decade before the event. Published online Sept. 23 in JAMA Cardiology, the findings point to a long period in which functional health may offer clinicians additional information, but they do not show that decline causes cardiovascular disease.
Aung Zaw Zaw Phyo of Monash University in Melbourne and colleagues analyzed participants in 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. Researchers compared changes in measures of functional aging in the years leading up to events.
Before an event, the case group had consistently higher frailty and lower intrinsic capacity and physical health-related quality of life than controls. The gaps widened markedly during the five years before the event. Over time, cases also showed faster deterioration in the study’s frailty measures and steeper declines in intrinsic capacity and physical quality of life.
The pattern was broadly similar across components of the cardiovascular disease composite, but the timing varied. Differences appeared at least 10 years beforehand for heart failure and fatal coronary heart disease, while divergence for myocardial infarction and stroke was not reported as occurring as early. The report does not provide an individual prediction threshold or show that these measures can identify who will have an event.
A Longer Window for Clinical Attention
The findings matter because cardiovascular risk is often discussed through established factors such as blood pressure, cholesterol and smoking, while a person’s ability to function can also reflect changes across several body systems. The study suggests that functional measures may worsen long before a diagnosis or event, potentially giving clinicians more time to notice changes and review a patient’s overall health.
The authors said the results suggest a prolonged opportunity for closer clinical evaluation and early intervention. That is an interpretation of the observed trajectories, not proof that acting on a frailty score or physical-capacity measure will prevent a heart attack, stroke or other event. The study does not test a specific intervention, and its results should not be treated as a basis for people to self-diagnose cardiovascular disease.
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How Researchers Tracked Functional Aging
The analysis was a nested case-control study using data from the Aspirin in Reducing Events in the Elderly cohort. Researchers compared people who experienced cardiovascular events with matched participants who did not, examining measures over time rather than looking only at health status at the moment of diagnosis.
The measures covered different aspects of function: frailty, intrinsic capacity and physical health-related quality of life. The paper, titled “Multidimensional Aging Trajectories Preceding Cardiovascular Events,” was published in JAMA Cardiology in 2026. The results describe associations and trajectories in this cohort; they do not establish why the differences emerged.
“Declines in functional aging markers were prominent before clinically apparent CVD.”
— Aung Zaw Zaw Phyo and co-authors
Prediction and Cause Remain Unproven
The study reports that functional decline and later cardiovascular events occurred in the same participants, but it cannot establish that one caused the other. The supplied report does not specify whether changes in frailty or capacity add predictive value beyond standard cardiovascular risk factors, or how accurately they might distinguish people who will have an event from those who will not.
It also does not identify a particular screening schedule, cutoff score or intervention proven to reduce cardiovascular events. The study’s findings come from participants in one cohort; whether the same timing and patterns apply to other populations is not established by the report. The reasons for the earlier divergence noted for heart failure and fatal coronary heart disease also remain unclear.
Testing Use in Routine Care
The immediate next step is to determine whether these functional measures can improve risk assessment in other groups and whether changes in them can guide care in a way that improves outcomes. Future research would need to test predictive accuracy, account for established risk factors and evaluate specific clinical responses, rather than infer benefit from the timing of decline alone.
For now, the paper adds evidence that functional health can change years before a recorded cardiovascular event in this cohort. The report does not announce a new clinical guideline or recommend that patients alter treatment based on these measures; the practical implications remain a question for further study.
Key Questions
How long before a cardiovascular event did functional differences appear?
The researchers reported poorer functional profiles as far as 10 years before an event. Differences widened markedly in the five years before it. The timing varied by event type, with earlier divergence reported for heart failure and fatal coronary heart disease.
What did the researchers mean by functional decline?
They examined frailty, intrinsic capacity and physical health-related quality of life. These measures capture aspects of a person’s overall physical function; the report does not describe them as a standalone cardiovascular diagnosis.
Does the study prove that functional decline causes heart disease?
No. The analysis found patterns preceding events, but it does not establish cause and effect or explain why the decline occurred.
Does the study recommend a new screening test?
No specific test, cutoff or screening schedule was established in the report. The authors said the findings may support closer clinical evaluation, but whether using these measures improves prediction or outcomes requires further study.
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