Loss of smell in over-70s indicates higher risk of stroke and heart disease

In clinical medicine, early warning systems rarely arrive as dramatic alarms. More often, they whisper.

A growing body of research suggests that declining olfactory function in older adults may be one of those whispers — a subtle sensory change reflecting broader systemic health vulnerability.

Recent coverage has highlighted findings that adults over 70 experiencing smell loss may face increased risk of cardiovascular events such as stroke and heart disease. While individual articles vary in framing, the scientific foundation behind this narrative is well established: olfactory decline is increasingly recognized as a biomarker of aging, neurological integrity, and vascular health.

A sensory signal with systemic meaning

One of the most influential studies in this area followed more than 3,000 adults aged 57–85 and found that those with severe smell impairment were over three times more likely to die within five years compared with peers with intact olfaction. 

This association persisted even after accounting for age, socioeconomic factors, and underlying medical conditions — suggesting smell loss was not merely a byproduct of disease, but an independent indicator of vulnerability. 

Subsequent analyses reinforced the pattern. Individuals with poorer olfactory performance demonstrated elevated long-term mortality risk, including deaths related to cardiovascular and neurodegenerative disease. 

The implication is profound: the sensory system may function as an integrative health dashboard, reflecting cumulative biological stress across multiple organ systems.

Why smell and vascular health may intersect

Several mechanisms have been proposed:

1. Shared vascular pathways

Olfactory processing depends on robust blood supply to nasal epithelium and brain structures. Vascular compromise affecting cerebral circulation may therefore manifest first as sensory decline.

2. Regenerative biology as a mirror of aging

The olfactory system is one of the few neural systems with continuous cellular turnover. Reduced smell function may signal diminished regenerative capacity — a hallmark of systemic aging.

3. Environmental and metabolic exposure

Because olfactory neurons interface directly with the external environment, cumulative exposure to pollutants, pathogens, and inflammatory processes may affect both smell and cardiovascular risk trajectories.

Together, these hypotheses position olfaction as a sentinel system — biologically exposed, metabolically demanding, and neurologically integrated.

Clinical and public-health implications

Despite decades of emphasis on vision and hearing screening, smell remains largely absent from routine health assessment. Yet research indicates that a simple odor identification test may offer meaningful predictive value for future health outcomes. 

For aging populations, this reframes smell not as a lifestyle inconvenience but as a potential screening dimension for healthy longevity.

From a public-health perspective, incorporating olfactory evaluation into geriatric assessment could:

• Identify individuals at elevated cardiovascular or neurodegenerative risk

• Support earlier intervention and monitoring

• Improve nutrition, safety, and quality of life outcomes

• Advance precision-aging frameworks that integrate sensory health

A sensory lens on longevity

The emerging science does not suggest that smell loss causes stroke or heart disease. Rather, it reveals something more nuanced: the sensory system reflects the organism.

When smell fades, it may indicate underlying shifts in vascular integrity, neural health, immune function, or regenerative capacity.

For researchers, clinicians, and policymakers, the nose is a diagnostic terrain.

Further reading

• University of Chicago News — Decreased ability to identify odors can predict death

• National Institute on Aging — Loss of sense of smell may predict mortality risk among older people

• PLOS ONE study (PMC) — Olfactory Dysfunction Predicts 5‑Year Mortality in Older Adults

• Harvard Health — Poor sense of smell may predict risk of death in older adults