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A JAMA Cardiology study found that participants 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. The gaps widened in the five years before an event, but the observational analysis does not show that functional decline causes cardiovascular disease or establish a screening approach.
A study of 12,015 participants found that people who later experienced cardiovascular disease events had poorer functional health than matched peers as far as 10 years before an event, with the differences widening in the final five years. Published online Sept. 23 in JAMA Cardiology, the analysis suggests that changes in frailty and physical function may provide a long period for clinicians to monitor health, but it does not show that those changes cause heart disease.
Aung Zaw Zaw Phyo of Monash University in Melbourne and colleagues analyzed participants in the Aspirin in Reducing Events in the Elderly (ASPREE) cohort. The analysis compared 2,403 people who experienced a cardiovascular event with 9,612 matched controls. Researchers examined measures of functional aging over time, including frailty, intrinsic capacity and physical health-related quality of life.
Compared with controls, people who later had an event showed higher frailty, lower intrinsic capacity and poorer physical health-related quality of life in the years leading up to it. The groups’ profiles differed as much as a decade before an event; the gaps widened markedly in the five preceding years, as the cases showed faster deterioration across the measures.
The authors reported increases in frailty and declines in intrinsic capacity and physical quality of life over time. Similar patterns appeared across the cardiovascular event categories examined, but the timing was not identical: divergence appeared at least 10 years before heart failure and fatal coronary heart disease, while it emerged later for myocardial infarction and stroke. The report does not provide enough detail to interpret the reported statistical coefficients as direct clinical changes for an individual.
A Longer Window for Clinical Review
The findings matter because cardiovascular risk is often discussed in terms of identifiable risk factors and disease itself, while this analysis tracks changes in day-to-day functional health years before an event. If further research confirms that these patterns can help identify people who may benefit from closer evaluation, clinicians could have more time to review cardiovascular risk and overall health before a major event becomes clinically apparent.
That possibility remains a research implication, not a tested clinical recommendation. The study shows an association between worsening functional measures and later cardiovascular events; it does not establish that measuring frailty or quality of life predicts an individual’s outcome, nor that an intervention prompted by those measures prevents an event. Readers should not interpret functional decline alone as a diagnosis of cardiovascular disease.
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How Researchers Tracked Aging
The report is based on a nested case-control analysis within ASPREE, a cohort whose participants were assessed before the events examined in this study. Researchers compared people who experienced cardiovascular disease with matched participants who did not, then examined how several measures changed in the preceding years. The measures capture different aspects of health: frailty, intrinsic capacity and physical health-related quality of life.
The article, “Multidimensional Aging Trajectories Preceding Cardiovascular Events,” was published in JAMA Cardiology on Sept. 23, 2026. The report identifies Phyo and colleagues as the study team and gives the paper’s DOI as 10.1001/jamacardio.2026.3597. Its findings concern patterns in a group of participants, not a diagnostic test validated for routine use.
““Declines in functional aging markers were prominent before clinically apparent CVD.””
— Aung Zaw Zaw Phyo and colleagues
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Limits on Prediction and Prevention
The analysis does not establish why functional decline and cardiovascular events were associated, or whether worsening function contributes to disease, reflects underlying health changes, or is related to other factors. It also does not show how accurately these measures predict an event for any one person, or provide a threshold that clinicians could use as a screening test.
The report gives no evidence that acting on the functional measures would prevent heart failure, coronary events, heart attacks or strokes. The cohort and study design also limit how far the findings can be applied to other populations. Further work would be needed to test whether these trajectories can guide care and whether early evaluation based on them improves outcomes.
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Testing These Signals in Care
The immediate next step is further research to determine whether functional measures can add useful information to established cardiovascular assessments. Studies would need to evaluate their predictive performance across different groups and establish whether changes in care prompted by those signals lead to better health outcomes.
Until that evidence is available, the findings are best understood as a long-term pattern identified in an observational analysis, rather than guidance for patients or a new screening standard. The study authors’ call for closer evaluation points to a possibility for future investigation; the report does not announce a clinical program or specify a next trial.
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Key Questions
What did the study find?
Participants 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 the event.
How many people were included?
The analysis included 12,015 ASPREE participants: 2,403 people who experienced a cardiovascular event and 9,612 matched controls.
Does the study show that functional decline causes heart disease?
No. It reports an association over time, but does not establish that functional decline causes cardiovascular disease or explain the relationship.
Does functional decline mean someone will have a cardiovascular event?
No. The study does not establish an individual prediction test or show that these measures can determine whether a person will have an event. Functional changes alone should not be treated as a diagnosis.
What should happen next?
Further research is needed to test whether these measures improve cardiovascular risk assessment and whether interventions based on them improve outcomes. The report does not provide a new screening recommendation.
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