Researchers have found in a new study that older adults with poor olfaction, or a reduced sense of smell, are at a significantly higher risk of developing coronary heart disease (CHD). The study concluded that individuals with poor olfactory function had up to double the risk of CHD during the early years of follow-up, suggesting that smell impairment could serve as an early marker of cardiovascular risk in the aging population. The study was published in JAMA Otolaryngology–Head & Neck Surgery by Keran W. and colleagues.
Olfactory decline is a common yet often overlooked issue among older adults. While reduced smell has been associated with neurodegenerative conditions such as Parkinson’s disease and dementia, its potential link with cardiovascular outcomes has not been thoroughly examined. Researchers conducted a detailed population-based analysis using data from the Atherosclerosis Risk in Communities (ARIC) Study, a long-term cohort investigating cardiovascular health across U.S. communities.
This retrospective cohort study analyzed secondary data from 5,142 participants aged around 75 years (mean [SD], 75.4 [5.1]) who had no prior CHD. The cohort included 62.9% females (n = 3,234), 23.9% Black participants (n = 1,230), and 76.1% White participants (n = 3,912). Olfactory function was evaluated using a 12-item odor identification test, classifying smell ability as good (scores 11–12), moderate (scores 9–10), or poor (scores 0–8). Participants were followed for up to 9.6 years (median 8.4 years) from 2011–2020. Data were analyzed between March 2024 and January 2025.
The primary outcome was the incidence of adjudicated CHD events, including myocardial infarction and coronary death. Researchers employed a discrete-time subdistribution hazard model to estimate absolute CHD risk across olfactory categories, adjusting for covariates such as age, sex, race, blood pressure, cholesterol, and smoking status. The analysis accounted for competing risks of death, and findings were validated using time-varying and period-specific Cox regression models.
Key Findings
During follow-up, 280 new CHD events (5.4%) occurred. Participants with poor olfaction had significantly higher CHD risk in the early years after testing:
Year 2: Risk ratio 2.06 (95% CI, 1.04–4.53)
Year 4: Risk ratio 2.02 (95% CI, 1.27–3.29)
Year 6: Risk ratio 1.59 (95% CI, 1.13–2.35)
Year 8: Risk ratio 1.22 (95% CI, 0.88–1.70)
Year 9: Risk ratio 1.08 (95% CI, 0.78–1.44)
This large cohort study found that poor olfaction was associated with an increased risk of coronary heart disease in older adults, particularly during the first six years of follow-up. The results underscore that a reduced sense of smell may serve as an early indicator of cardiovascular vulnerability. Identifying olfactory impairment could offer a new, noninvasive approach to detecting individuals at elevated risk for heart disease and guiding early preventive strategies.
Reference:
Chamberlin KW, Li C, Kucharska-Newton A, et al. Olfaction and Coronary Heart Disease. JAMA Otolaryngol Head Neck Surg. Published online October 30, 2025. doi:10.1001/jamaoto.2025.3740
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