Academic journal article Generations

Coronary Artery Disease in Later Life

Academic journal article Generations

Coronary Artery Disease in Later Life

Article excerpt

Coronary artery disease occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The arteries harden and narrow because of the buildup of plaque (atherosclerosis).

PREVALENCE AND IMPORTANCE

Over the past century, advances in medical and procedural interventions for coronary artery disease have lengthened the life expectancy of people in the United States and improved their quality of life. Yet, with demographic shifts, more individuals of increasingly older ages are coming to a healthcare provider for evaluation and treatment of coronary disease. Coronary artery disease is a major cause of death and disability in older adults (American Heart Association Statistics Committee, 2006). This year an estimated 700,000 Americans will suffer their first heart attack, and 500,000 more will have a recurrent heart attack (NIH/ARIC, 1987-2000). The average age of a first heart attack is 65.8 years for men and 70.4 years for women (NIH/ARIC, [year]), with more than 80 percent of the deaths from coronary disease occurring in individuals over age 65 (Kochanek and Smith, 2004). For those older adults who survive an initial heart attack, many progress to congestive heart failure, chronic angina (chest pain), or arrhythmias (irregular heart rhythms), resulting in significant cardiovascular disability and chronic care costs. Coronary artery disease cost an estimated $142.5 billion dollars in 2006 (American Heart Association Statistics Committee, 2006) and accounts for the primary diagnosis at admission in up to a quarter of nursing-home residents older than age 65 (U.S. National Center for Health Statistics, 2002).

The risks and benefits of treatment differ for elders compared to younger people, and consideration also must be given to individual heterogeneity and goals for care. While data for coronary artery disease in the oldest old are sparse, the heterogeneity of aging itself makes a "one-size-fits-all" approach inappropriate. This article provides an overview of coronary artery disease as it affects older people, considering patient factors and treatment options that influence cardiovascular health.

CORONARY RISK FACTORS AND AGING

Risk factors and lifestyle are important contributors to coronary disease, regardless of age. In a large study of patients with first heart attacks, nine modifiable risk factors were found to explain more than 90 percent of the coronary risk in subjects compared to controls (Yusuf et al., 2004). Independent risk factors included cigarette smoking, high cholesterol, hypertension, diabetes mellitus, abdominal obesity, sedentary lifestyle, low intake of fruit and vegetables, and psychosocial stress. These factors remained significant regardless of age, gender, ethnicity, or geographical location.

The Cardiovascular Health Study evaluated these and other risk factors for cardiovascular disease specifically in an older population (Fried et al., 1998). In this age 65 and older population, healthy lifestyle factors like exercise, no smoking, low-fat diet, and smaller waist circumference, as well as an absence of concurrently existing conditions like hypertension, hyperlipidemia (excess fat in the blood), and diabetes, were associated with better health during follow-up. In fact, chronological age was a minor predictor of risk after accounting for these factors and disease that did not yet show clinical manifestations (referred to as subclinical) (BiId et al., 1993).

A single glass of red wine daily (Burke et al., 2001) and moderate caloric restriction (Heilbronn et al., 2006) have also been demonstrated to reduce cardiovascular and age-related risks. Remaining involved in the community is another important avenue to maintaining function and quality of life, and preventing health complications. Fortunately, in the Cardiovascular Health Study, maintenance of health appeared to be the norm in older adults, with the majority of this older population remaining free of chronic disease over six and a half years of follow-up (Burke et al. …

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