Cardiovascular disease has been identified as the leading cause of morbidity and mortality in developed countries. Given the increase in life expectancy and the development of cardiovascular preventive measures, it has become increasingly important to detect and prevent
cardiovascular diseases in the elderly. We reviewed the scientific literature concerning cardiovascular prevention to assess the importance of cardiovascular preventive measures in old (> or =65 years of age) individuals.
METHODS: We undertook a systematic search for references relating to prevention of
cardiovascular disease in the elderly, mainly
ischaemic stroke,
coronary artery disease and
heart failure, on the MEDLINE database 1962-2005. For cardiovascular prevention by drugs or surgery, emphasis was placed on randomised controlled trials, review articles and meta-analyses. For cardiovascular prevention by lifestyle modification, major cohort studies were also considered.
RESULTS:
Stroke,
coronary heart disease and
heart failure were found to be the main targets for cardiovascular prevention in published studies.
Antihypertensive treatment has proven its efficacy in primary prevention of fatal or nonfatal
stroke in hypertensive and high-risk patients >60 years of age, particularly through treatment of
systolic hypertension. Systolic blood pressure reduction is equally important in the
secondary prevention of
stroke. Similarly, in nonvalvular
atrial fibrillation, an adjusted dose of
warfarin with a target International Normalized Ratio (INR) of between 2 to 3 prevents
ischaemic stroke in elderly patients with an acceptable haemorrhagic risk but is still under prescribed.
Antiplatelet agents are indicated in elderly patients with nonembolic
strokes. Few large-scale studies have investigated the effect of
HMG-CoA reductase inhibitors (
statins) on
stroke prevention in old individuals. To date, the largest trials suggest a beneficial effect for
stroke prevention with use of
statins in high-risk elderly subjects < or =82 years of age.
Carotid endarterectomy is indicated in
carotid artery stenosis >70% and outcomes are even better in elderly than in younger patients. However, medical treatment is still the first-line treatment in asymptomatic elderly patients with <70%
stenosis. In ischaemic
heart disease, different trials in elderly individuals have shown that use of
statins,
antithrombotic agents,
beta-adrenoceptor antagonists and
ACE inhibitors plays an important role either in primary or in secondary cardiovascular prevention.
Hormone replacement therapy has been used to treat climacteric symptoms and
postmenopausal osteoporosis and was thought to confer a cardiovascular protection. However, controlled trials in elderly individuals changed this false belief when it was found that there was no benefit and even a harmful cardiovascular effect during the first year of treatment. Smoking cessation, regular physical activity and healthy diet are, as in younger individuals, appropriate and effective measures for preventing cardiovascular events in the elderly. Finally,
antihypertensive treatment and
influenza vaccination are useful for
heart failure prevention in elderly individuals.
CONCLUSIONS: Cardiovascular prevention should be more widely implemented in the elderly, including individuals aged > or =75 years, and this might contribute to improved healthy status and quality of life in this growing population.