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A study published online Sept. 23 in JAMA Cardiology 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 observational findings describe patterns before events; they do not show that functional decline causes cardiovascular disease or that the measures can predict an individual’s risk.
A study published online Sept. 23 in JAMA Cardiology found that people who later experienced cardiovascular disease events had worse measures of frailty, intrinsic capacity and physical health-related quality of life years before an event was recorded. The analysis covered 12,015 participants in the ASPREE cohort and found that differences were present up to a decade beforehand, widening in the five years before an event.
Researchers led by Aung Zaw Zaw Phyo of Monash University in Melbourne examined functional-performance patterns among 2,403 people who experienced a cardiovascular event and 9,612 matched controls. The data came from the Aspirin in Reducing Events in the Elderly (ASPREE) cohort. The study, titled “Multidimensional Aging Trajectories Preceding Cardiovascular Events,” was published in JAMA Cardiology.
Compared with controls, participants who later had an event showed higher frailty, lower intrinsic capacity and poorer physical health-related quality of life. The researchers reported faster worsening over time among those with events: increases in scores on two frailty measures and steeper declines in intrinsic capacity and physical quality of life. The reported trajectory estimates were Frailty Index β = 0.78, Fried phenotype frailty β = 0.05, intrinsic capacity β = −0.34 and physical health-related quality of life β = −0.55.
The broad pattern appeared across components of the cardiovascular disease composite, but the timing varied. The report says divergence emerged at least 10 years before heart failure and fatal coronary heart disease, while differences before myocardial infarction or stroke appeared later. The source does not provide the event counts by subtype or enough detail to interpret the estimates as individual risk predictions.
A Longer Window for Clinical Attention
The findings matter because they place measurable changes in physical function and broader health status well before a cardiovascular event becomes clinically apparent. If similar patterns are confirmed and made useful in clinical settings, they could help clinicians consider worsening function as part of a person’s overall health picture rather than focusing only on conventional cardiovascular symptoms.
The authors say the results suggest a prolonged period for closer clinical evaluation and early intervention. That is an implication, not a tested outcome of this analysis: the study did not establish that screening for these measures prevents heart attacks, strokes or other events, nor did it test a specific intervention. The findings also do not mean that an individual with declining function will necessarily develop cardiovascular disease.
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How Researchers Tracked Aging Measures
This was a nested case-control study using participants from ASPREE, a cohort whose name refers to the Aspirin in Reducing Events in the Elderly study. Researchers compared people who experienced a cardiovascular event with matched participants who did not, examining functional-aging measures in the years leading up to the event. The analysis is reported in the journal article by Phyo and colleagues, with DOI 10.1001/jamacardio.2026.3597.
Frailty measures, intrinsic capacity and health-related quality of life describe different aspects of functioning and health. Their inclusion allowed researchers to assess several dimensions rather than a single physical measure. The report describes associations and trajectories over time; it does not establish why the groups differed or show that functional decline itself caused cardiovascular disease.
“Declines in functional aging markers were prominent before clinically apparent CVD.”
— Aung Zaw Zaw Phyo and colleagues, in the JAMA Cardiology report
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Prediction and Causation Remain Unproven
The analysis shows that group-level functional measures differed before events, but the available report does not establish whether those measures can predict an event accurately for an individual. It also does not show that functional decline causes cardiovascular disease or that reversing a decline would prevent an event. The study did not test a screening program or early treatment strategy.
Details needed to judge clinical usefulness—including the performance of any proposed risk tool, results by participant characteristics and the full event counts for each cardiovascular outcome—are not included in the source report. The association may reflect several overlapping health changes; the authors’ multisystem-aging explanation is an interpretation, not a proven mechanism.
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Further Testing Before Clinical Use
The next step is to determine whether these trajectories hold in other groups and whether functional-aging measures add useful information beyond existing cardiovascular risk assessments. Further research would also need to test whether clinicians can act on such measures in a way that improves outcomes, rather than merely identifying people whose function is changing.
For now, the study adds evidence that functional decline can precede cardiovascular events by years, but it does not change individual diagnosis or treatment guidance. The reported publication is the current development; the source material does not identify a planned follow-up study or a timetable for clinical recommendations.
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Key Questions
What did the study find?
Among 12,015 ASPREE participants, those who later experienced a cardiovascular event had worse frailty, intrinsic capacity and physical health-related quality-of-life profiles than matched controls. Differences were present up to a decade beforehand and widened in the five years before an event.
Does functional decline cause cardiovascular disease?
The study does not establish cause and effect. It reports that functional measures changed differently in the years before events; the authors’ explanation involving multisystem aging remains an interpretation.
Can these measures predict an individual heart event?
The report does not show that the measures can accurately predict an event for an individual. It describes group-level trajectories and does not evaluate a clinical prediction tool.
Which events showed the earliest differences?
The report says divergence appeared at least 10 years before heart failure and fatal coronary heart disease. Differences before myocardial infarction or stroke appeared later, though the source does not give precise timing for those outcomes.
Does the study recommend a new screening test?
No specific screening test or treatment recommendation is reported. The authors suggest closer clinical evaluation and early intervention may be worth considering, but the study did not test whether either approach prevents cardiovascular events.
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