How Aging Can Signal Heart Risk

Edited and Approved by Stephen C. Rose, PhD, MS

A cardiovascular event can seem sudden, but the changes leading up to it may develop over years. A new study asks whether an older person's everyday functioning carries clues about that process. The findings suggest that changes in strength, mobility, and overall health deserve attention alongside familiar cardiovascular risk factors. They also offer a practical message: protecting function and checking heart risk belong in the same conversation.

This does not mean that becoming slower predicts an impending heart attack. It means that a persistent change from your usual abilities can provide useful information for a clinical assessment. Understanding the distinction helps us act on the research without making it more precise than it is.

What the new study found

Researchers examined 12,015 older adults from the ASPREE cohort: 2,403 who experienced a cardiovascular event and 9,612 controls matched by age, sex, and education. Most entered at age 70 or older, without previous overt cardiovascular events, dementia, or substantial physical disability. This was an observational analysis of cohort data, although ASPREE originally tested aspirin. [1]

Annual measurements included a 64-item frailty index, a physical frailty assessment, modified intrinsic capacity, and reported physical quality of life. Intrinsic capacity combined cognition, walking, grip strength, and psychological well-being. These assessments describe how people function, rather than assigning them a molecular or epigenetic age. [1]

People who subsequently developed cardiovascular disease had worse functional profiles years beforehand. Group differences widened especially during the final five years before an event. Divergence was generally earlier for heart failure and fatal coronary heart disease, at least a decade beforehand, than for heart attack or stroke. The sample was predominantly White and healthier than many older populations. [1]

The importance lies in the pattern over time. An isolated measurement captures one day. Repeated assessments can reveal whether someone's usual level of functioning is changing. That makes the question at a routine visit more informative: what can you do now compared with what you could do previously?

Function reflects more than muscle strength

Frailty is a clinical concept describing reduced ability to withstand stress. As reserve declines across multiple systems, a relatively small illness or disruption can have a larger effect. Frailty is therefore broader than being thin, looking old, or having one diagnosis. It concerns how well the body maintains and restores stability when challenged. [2]

Think of reserve as the extra capacity available when ordinary demands increase. Two people may both manage their usual daily activities, yet respond very differently to an infection or a period of inactivity. This helps explain why calendar age alone cannot describe every older person's health or guide every treatment decision. [2]

The link between frailty and cardiovascular health is not entirely new. A meta-analysis of 18 cohorts, involving more than 31,000 people, found associations between frailty and cardiovascular disease. Its prospective studies also linked frailty with later cardiovascular events. Because these were observational data, the relationship does not establish that frailty itself caused the events. [3]

The useful connection with longevity is broader than survival. Preserving the ability to walk, shop, prepare meals, and participate in daily life is valuable in its own right. Research that connects function with future illness can help clinicians consider both disease prevention and the abilities a person wants to maintain.

A clue rather than a personal forecast

Group averages do not provide an individual countdown. Even if two groups differ years before an event, their members can overlap substantially. To become a useful prediction tool, an assessment must show how accurately it distinguishes people who will experience an event, how often it produces false alarms, and whether acting on its results improves outcomes.

The new analysis cannot determine whether functional decline reflects developing cardiovascular disease, contributes to it, or shares underlying causes with it. It therefore supports closer assessment rather than a diagnosis based on walking speed or weakness alone. [1]

For a reader, the practical implication is to provide a clearer history, not to calculate a score from the paper. Saying that a familiar walk has become harder over several months is more useful than simply reporting that you feel older. A clinician can interpret the change in the context of symptoms, existing conditions, medications, examination, and established cardiovascular risks.

What intervention studies already support

There is evidence that function can be protected. The LIFE trial randomized 1,635 sedentary adults aged 70 to 89 who had physical limitations but could still walk 400 meters. A structured program of aerobic, resistance, and flexibility activities reduced major mobility disability compared with health education. Over an average 2.6 years, disability occurred in 30.1% of the activity group and 35.5% of the comparison group. [4]

That result supports maintaining mobility through appropriate activity. It does not establish that improving a walking measurement prevents the cardiovascular events described in the new study. Different trials answer different questions, and their benefits should be described accordingly.

Established cardiovascular prevention remains important in later life. Among 2,636 SPRINT participants aged at least 75 with hypertension but without diabetes, intensive blood-pressure treatment reduced major cardiovascular events and overall mortality compared with standard treatment. This supports effective treatment in appropriately selected older adults; it does not make the trial's intensive target appropriate for everyone. Treatment needs to account for tolerability, other conditions, and clinical circumstances. [5]

Aspirin illustrates why preventive treatments require individual decisions. In ASPREE, low-dose aspirin did not significantly reduce cardiovascular events in generally healthy older adults, and it increased major bleeding. The cohort's name is not a reason to start aspirin. Nor should this finding prompt someone to stop prescribed treatment for an established cardiovascular condition without discussing its purpose. [6]

How you may be able to benefit

Begin by paying attention to changes in ordinary activities. Notice whether your usual walking route, stairs, carrying groceries, or getting out of a chair has become persistently harder. Record what changed and approximately when, and bring that history to a routine appointment. These examples help describe function; they are not home tests that diagnose heart disease.

Use that appointment to review established risks as well as daily abilities. The National Heart, Lung, and Blood Institute emphasizes knowing your cardiovascular risk, checking blood pressure and cholesterol, avoiding smoking, getting regular activity, and choosing heart-healthy foods. Functional concerns can make this conversation more complete, while the familiar risk factors still deserve their own assessment. [7]

Build activity around your present abilities. CDC guidance for adults 65 and older includes at least 150 minutes of moderate aerobic activity each week, muscle-strengthening activity on at least two days, and balance activities. If those goals are currently out of reach, be as active as your abilities and conditions allow. Some activity is better than none. An appropriate program can begin with manageable sessions and progress gradually. [8]

Diet offers another practical starting point. In the original DASH trial, a pattern rich in fruit, vegetables, and low-fat dairy, with less saturated and total fat, lowered blood pressure while body weight and sodium intake were held constant. The finding supports a dietary benefit beyond weight loss alone. [9]

NIH guidance translates this into ordinary choices: vegetables, fruit, whole grains, beans, nuts, and suitable protein sources, with less saturated fat and fewer sugary drinks. Try oats and fruit at breakfast, beans in a meal, or fish in place of a processed-meat meal. Choose portions that fit your needs. These steps apply established nutritional guidance rather than a diet derived from the new aging study. [10]

Choose goals that matter in daily life, such as keeping up a familiar walk or maintaining independence with shopping. The new research gives further reason to take changing function seriously. Its strongest immediate value is to encourage a broader clinical conversation and timely use of prevention measures with established benefits.

References

[1] Phyo AZZ, Wu Z, Tonkin AM, et al. Multidimensional Aging Trajectories Preceding Cardiovascular Events. JAMA Cardiol. Published online September 23, 2026. e263597. doi:10.1001/jamacardio.2026.3597.

[2] Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet. 2013;381(9868):752-762. doi:10.1016/s0140-6736(12)62167-9.

[3] Veronese N, Cereda E, Stubbs B, et al. Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis. Ageing Res Rev. 2017;35:63-73. doi:10.1016/j.arr.2017.01.003.

[4] Pahor M, Guralnik JM, Ambrosius WT, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA. 2014;311(23):2387-2396. doi:10.1001/jama.2014.5616.

[5] Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. JAMA. 2016;315(24):2673-2682. doi:10.1001/jama.2016.7050.

[6] McNeil JJ, Wolfe R, Woods RL, et al. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med. 2018;379(16):1509-1518. doi:10.1056/nejmoa1805819.

[7] National Heart, Lung, and Blood Institute. Heart-Healthy Living. National Institutes of Health. Accessed September 30, 2026.

[8] Centers for Disease Control and Prevention. Older Adult Activity An Overview. Updated December 4, 2025. Accessed September 30, 2026.

[9] Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336(16):1117-1124. doi:10.1056/nejm199704173361601.

[10] National Heart, Lung, and Blood Institute. DASH Eating Plan. National Institutes of Health. Updated February 25, 2026. Accessed September 30, 2026.