A newly published review article has investigated the possible ways of preventing cardiovascular diseases in the elderly; statin therapy, blood pressure control and changes in the lifestyle can contribute to a lower cardiovascular risk
Prevention of cardiovascular disease (CVD) is challenging in older adults. Some assume that they might not benefit from the preventive therapy, however, they usually have an intermediate/high CV risk, and their risk reduction is usually higher than in younger patients. The therapy is more complex in the elderly, because of the possible drug interactions and comorbidities.
A new review article published in the Canadian Journal of Cardiology, the authors collected the current information available on the prevention of CVD in older adults. They found that there is no clinical support tool designed to assess the CV risk in patients older than 75 years. The Framingham Risk Score (FRS) can be used in older adults, but as age is the largest contributor to CV risk, men above the age of 75 years are at high risk, while women in the same age group are at least at an intermediate risk. The FRS, therefore, does not allow individual assessment.
It seems that statin therapy (lipid lowering drug) can be beneficial in CV prevention. In the PROSPER trial, researchers found that statin therapy lowered the risk of coronary heart disease death, nonfatal heart attack and nonfatal stroke compared to a non-treated group. In the HPS study, statin treatment reduced the incidence of major vascular events in patients older than 70 years. Furthermore, a meta-analysis shows that with statin therapy, heart attack and stroke incidence can be reduced in patients 65 years or older without previous CVD. However, statin therapy has adverse effects too. Studies have shown that statin therapy does not contribute to cognitive impairment and it does not cause dementia and Alzheimer disease, however, cognitive impairment might occur with statin therapy as a rare reaction. Another adverse effect of statin therapy is myopathy, but it is not yet confirmed that it occurs more frequently in older adults. A higher cancer risk was only reported in one study in pravastatin treatment, while new-onset diabetes was more prevalent in statin therapy. Statins are known to interact with many prescription and over-the-counter drugs by lowering or increasing the statin level in the blood, so the drug-drug interactions should be taken into consideration before starting the treatment in order to avoid statin toxicity. The individual life expectancy is also an important factor in statin therapy, because the treatment does not have beneficial short term effects.
More than two-thirds of adults older than the age of 60 years have hypertension. Research shows that adequate treatment might reduce the risk of all CV events and stroke, and that diuretic therapy might also decrease the risk of coronary events. However, it seems that a moderate decrease in blood pressure is more beneficial in older adults, and that a more intensive reduction might have adverse effects. There is evidence that Beta-blockers should not be used in this age group. Diabetes can also contribute to cardiovascular risk, however, an intensive glycemic control has not been shown to reduce cardiovascular events or mortality. Anticoagulation therapy (such as ASA) is frequently used in the prevention of cardiovascular diseases, but researchers found that this therapy does not reduce stroke, CV death, serious vascular events and mortality in patients older than 65 years. On the other hand, researchers observed that the incidence of serious bleeding was almost twofold higher with ASA. As smoking is also a risk factor in CVD, and quitting reduces the risk of death within 1-2 years, smoking cessation should be encouraged in all older adults. The contribution of physical activity to CV prevention is well known and even a small amount of exercise in older adults might lead to overall improved survival. Diet and weight are also contributors and the Mediterranean diet has shown to reduce adverse CV events by 30%. It seems, however, that in patients over the age of 70 years, low weight is a risk factor for cardiovascular mortality, while in case of overweight and obese patients the CV mortality risk is not increased.
CVD is the leading cause of death in the elderly, therefore CV prevention in this population is extremely important; however prevention is challenging and should be individualized. Statin therapy, blood pressure control and healthy diet might reduce the risk of CVD, while anticoagulants and weight loss do not seem to contribute.
Written By: Dr. Fanni R. Eros