Functional Decline Precedes Cardiovascular Disease Events By Many Years

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A JAMA Cardiology study found that people who later experienced cardiovascular disease events had worse frailty, intrinsic capacity and physical health-related quality of life than matched controls as far as a decade beforehand. The gaps widened markedly in the five years before an event, but the findings do not establish that functional decline causes cardiovascular disease or provide a screening test.

People who later experienced a cardiovascular disease event showed worse frailty, physical function and health-related quality of life than matched peers up to a decade before the event, according to a study published online September 23 in JAMA Cardiology. The differences widened particularly in the final five years, suggesting that measurable changes in functional health may precede a diagnosed event, though the study does not show that those changes cause one.

Aung Zaw Zaw Phyo of Monash University in Melbourne and colleagues analyzed data from 12,015 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 changes over time in measures of frailty, intrinsic capacity and physical health-related quality of life.

Participants who later had an event had consistently poorer profiles than controls, and the gap grew in the five years immediately preceding it. Over time, the event group showed larger increases in frailty, measured using both the Frailty Index and Fried phenotype, and steeper declines in intrinsic capacity and physical health-related quality of life. The paper reports statistical trajectory estimates for these measures; they describe differences in change over time, not an individual’s probability of having an event.

The pattern appeared across components of the cardiovascular disease composite, but the timing differed. Differences appeared at least 10 years before heart failure and fatal coronary heart disease; for myocardial infarction and stroke, the researchers reported later divergence. The study was published as “Multidimensional Aging Trajectories Preceding Cardiovascular Events” in JAMA Cardiology, with DOI 10.1001/jamacardio.2026.3597.

A Longer Window for Clinical Attention

The findings matter because cardiovascular risk is often discussed in terms of diagnoses and conventional risk factors, while this analysis tracks broader changes in how people function as they age. If such changes are confirmed as useful in clinical settings, they could prompt closer assessment of a person’s health before a cardiovascular event becomes clinically apparent. The authors describe the patterns as a possible prolonged window for clinical evaluation and early intervention.

That possibility should not be mistaken for evidence that frailty scores can predict an event for an individual, or that treating functional decline will prevent one. This was an observational analysis of people who did and did not experience events; it identified associations and trajectories, not a tested screening program or intervention. The study also does not establish that functional decline is specific to cardiovascular disease rather than reflecting wider health changes.

How Researchers Tracked Aging

The analysis used participants in the Aspirin in Reducing Events in the Elderly cohort and compared measurements recorded in the years before cardiovascular events with those of matched controls. Rather than looking only at health near the time of diagnosis, the researchers examined long-term trajectories across several functional measures. This approach allowed them to report when group differences appeared and how they changed as an event approached.

Frailty, intrinsic capacity and physical health-related quality of life capture overlapping but distinct aspects of health and function. The report’s central finding is not that one measure independently forecasts a specific event, but that multiple functional indicators worsened more among those who later experienced cardiovascular disease. The reported exception in timing—earlier divergence for heart failure and fatal coronary disease than for heart attack or stroke—also cautions against treating all cardiovascular outcomes as following the same pattern.

“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 Causation Remain Open

The results show group-level differences before events, but the supplied report does not establish whether functional measures can accurately predict which individual will develop cardiovascular disease, or how they might perform as part of a clinical screening tool. It also does not show that changes in frailty or physical function directly cause an event. The analysis is observational, so other health factors may contribute to both functional decline and cardiovascular outcomes.

The available report does not specify enough detail to assess how the findings might apply beyond this cohort, or whether the measures could guide a particular intervention. It also gives no absolute event-risk estimates for people with particular functional profiles. Those limits mean the findings should not be used by readers to diagnose cardiovascular disease or alter care on their own; medical decisions should be discussed with a qualified health professional.

Testing the Clinical Use of Measures

The immediate next step is further research into whether these long-term patterns are reproduced in other populations and whether functional measures add meaningful information to existing cardiovascular assessments. Studies would also need to test whether using those measures to prompt clinical evaluation or early intervention changes health outcomes. The report provided no specific follow-up study, guideline change or clinical recommendation, so any practical use remains to be established.

Key Questions

How long before a cardiovascular event did functional differences appear?

The study found consistently worse functional profiles among people who later experienced an event as far as 10 years beforehand. Differences widened markedly during the five years before the event. Timing varied by outcome: divergence appeared earlier for heart failure and fatal coronary heart disease than for myocardial infarction or stroke.

Which measures did the researchers compare?

The researchers examined frailty, intrinsic capacity and physical health-related quality of life. Frailty was assessed using the Frailty Index and Fried phenotype. The report describes group trajectories across these measures, not a single diagnostic test.

Does the study show that functional decline causes heart disease?

No. The study found an association between worsening functional measures and later cardiovascular events. Its observational design does not establish that functional decline causes disease or that preventing the decline would prevent an event.

Can people use these findings to predict their own risk?

The report does not establish that the measures can predict an individual’s risk or provide a validated screening method. Anyone concerned about symptoms or cardiovascular risk should seek advice from a qualified health professional rather than relying on these study findings alone.

Source: rss