https://immattersacp.org/weekly/archives/2013/11/05/6.htm

AHA scientific statement targets atherosclerotic cardiovascular disease

The American Heart Association recently issued a statement on secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in the elderly.


The American Heart Association recently issued a statement on secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in the elderly.

The statement was prompted by a number of factors, including the aging of the population, and recent increases in incidence of stroke and peripheral artery disease, costs of treatments, and randomized, controlled trials of treatments. It is intended to clarify the benefits and risks of secondary prevention measures, and to increase the application of proven secondary prevention therapies in older patients. While the statement considered all patients ages 65 and older, it emphasized patients ages 75 and older, who have more pronounced age-associated challenges.

The statement appeared online Oct. 28 in Circulation.

Among the many considerations addressed by the statement, some included:

  • CHD in older adults. Providers must maintain a high index of suspicion for coronary heart disease in older patients, and should implement appropriate diagnostic and therapeutic strategies that comply with guidelines and with individual patient circumstances and preferences.
  • Stroke. Control of hypertension and hyperlipidemia have shown strong and consistent reduction in new and recurrent stroke risk, although the data on patients who are 80 or older are limited. Smoking cessation has similar benefits, and within 5 years of smoking cessation, the risk of stroke declines to that of people who never smoked.
  • PAD. The ankle-brachial index (ABI) remains the best screening test for PAD because of its simplicity, wide availability, low risk and low cost. While an ABI less than 0.9 suggests PAD, an ABI or more than 1.3 is more common in patients because of calcified, noncompressible arteries. Because of the high prevalence of asymptomatic PAD in older adults, those with claudication or atypical leg symptoms, as well as those with known coronary heart disease or previous stroke, should undergo ABI testing.
  • Obesity. Although both obesity and ASCVD are highly prevalent among seniors, there are considerably fewer data for older patients than for younger ones. And, the effect of weight loss interventions on achieving long-term weight reduction in older adults has been modest.

“Given the greater attributable risk associated with ASCVD in older adults in relation to morbidity, mortality, and decreased QOL, physical function, and personal independence, as well, beside higher health care costs, older patients are particularly likely to benefit from secondary prevention strategies,” the statement concluded. “Nonetheless, risks attributable to these therapies also increase for seniors in comparison with the younger populations on which evidence-based secondary prevention standards were based. Secondary prevention pharmacological, invasive, and lifestyle interventions are all technically feasible in older and younger adults with ASCVD, as well, but their risk-to-benefit ratios vary significantly.”