Cardiovascular Disease
Annals of Long-Term Care on the Web is a comprehensive resource for clinical information on geriatric medicine and long-term care as well as Cardiovascular Disease. We hope the articles below provide timely information for your practice.
Psychopharmacology in the Elderly Person with Cardiovascular Disease
Mental illness and cardiovascular disease are seen both individually and concomitantly with significant frequency in the elderly, with two of the most prevalent mental disorders being depression and psychosis. Proper pharmacologic treatment of both conditions using antidepressant and antipsychotic agents includes an understanding of various pharmacokinetic and pharmacodynamic considerations (eg, drug absorption, distribution, metabolism, excretion), as well as the direct effect these agents may have on elderly persons, who are often more sensitive to the therapeutic effects as well as the adverse effects of these drugs. Cardiotoxic effects (such as QT interval prolongation), increased cerebrovascular events, metabolic dysfunction, and increased risk of death have been attributed to some of these medications. The coadministration of psychoactive and cardiovascular-related medications is also common in this population, and adds particular complexity to the task of choosing an appropriate drug regimen that provides maximum clinical efficacy with minimal drug-drug interaction. Both older and newer generations of agents will be discussed here. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[5]:34-45)
Abstracts from Medical Literature for the Geriatrics Practitioner
Arch Intern Med 2004;164:55-60. ADDITIVE BENEFITS OF PRAVASTATIN AND ASPIRIN TO DECREASE RISKS OF CARDIOVASCULAR DISEASE Randomized trials of secondary prevention have shown pravastatin sodium and aspirin to reduce the risk of cardiovascular disease. It is suggested that health care providers should use the Vaccine Information Sheets developed by the Centers for Disease Control and Prevention to inform patients about the risks and benefits associated with the influenza and pneumococcal ...
Abstracts from Medical Literature for the Geriatrics Practitioner
Abstracts from Medical Literature for the Geriatrics Practitioner Abstracts from Medical Literature for the Geriatrics Practitioner Click here to download full article in PDF THE QUEST FOR NURSING HOME QUALITY The most criticized sector of the U.S. health care system are nursing homes. : EFFECT OF SUBCLINICAL CARDIOVASCULAR DISEASE Recent studies have shown cardiovascular diseases to be the primary cause of death in older adults. According to age-stratified summaries, younger subjects with ...
The Older Patient with Type 2 Diabetes: Special Considerations and Management with Insulin
It is well established that diabetes prevalence in the United States has reached an epidemic level and continues to increase. As the risk for diabetes increases with age, the importance of screening for diabetes among older patients is critical. Once diagnosed, diabetes in older persons must be managed on an individualized basis, according to the underlying comorbidities, level of functioning, and life expectancy of the patient. The health status of patients in older populations varies considerably; for many patients with a higher functional status, tight glycemic control is appropriate. Because these patients can benefit greatly from intensive therapy, it is important to identify and treat these older individuals without unnecessary delay. Treatment to glycemic targets eventually may require insulin therapy, either in combination with oral agents or alone in regimens that approach physiologic insulin secretion (ie, basal-prandial regimens). Caregivers should consider carefully the risks and benefits of insulin therapy for older patients with diabetes on a case-by-case basis, because insulin can safely provide the level of efficacy needed to reach and maintain glycemic targets for many patients. (Annals of Long-Term Care: Clinical Care and Aging 2007;14[11]:17-24)
Abstracts from Medical Literature for the Geriatrics Practitioner
This study examined the prevalence of prostate cancer among men in the Prostate Cancer Prevention Trial who had a PSA level of 4.0 ng/mL or less. The outcomes evaluated included total mortality, CHD mortality, nonfatal myocardial infarction, revascularization, and total CHD events. For women with known cardiovascular disease, treatment of hyperlipidemia is effective in reducing CHD events, CHD mortality, nonfatal myocardial infarction, and revascularization, but it does not affect total ...
Lower Gastrointestinal Bleeding in the Elderly
Lower gastrointestinal (GI) bleeding is an important cause of increased morbidity and mortality in the elderly. Its incidence increases with age and corresponds to the increased incidence of specific GI diseases more common in the elderly, comorbid illnesses, and polypharmacy. GI illnesses associated with lower GI bleeding that are more common in the elderly include diverticulosis coli, vascular ectasia, ischemic colitis, and colonic neoplasms. Comorbid illnesses include atherosclerotic cardiovascular disease, cerebrovascular disease, and malignancy. The evaluation of patients is adjusted to the rate and severity of hemorrhage and the clinical status of the patient. The physical examination may be complicated by the presence of visual, auditory, and cognitive impairment. Timing of tests and the type of intervention should be custom-tailored, especially for the frail elderly patient. With appropriate evaluation and management, a successful outcome can be achieved in the majority of elderly patients with lower GI bleeding. (Annals of Long-Term Care: Clinical Care and Aging 2007;15[4]:40-45)
Treatment of Peripheral Arterial Disease in the Elderly Person
Persons with peripheral arterial disease (PAD) are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease (CAD). Modifiable risk factors such as cessation of cigarette smoking and control of dyslipidemia, hypertension, and diabetes should be treated. Statins decrease the incidence of intermittent claudication and improve exercise duration, as well as reduce cardiovascular events and mortality in persons with PAD and hypercholesterolemia. Antiplatelet drugs and angiotensin-converting enzyme inhibitors should be administered to all persons with PAD. Beta-blockers should be given if CAD is present. Exercise rehabilitation programs and cilostazol improve exercise time until intermittent claudication. Indications for lower-extremity angioplasty or bypass surgery include incapacitating claudication, limb salvage in persons with limb-threatening ischemia, and impotence of vascular origin. Amputation should be performed if tissue loss has progressed beyond the point of salvage, if surgery is too risky, if life expectancy is very short, or if functional limitations reduce the benefit of limb salvage. (Annals of Long-Term Care: Clinical Care and Aging 2005;13[9]: 35-40)
Therapy of Older Persons With Ventricular Arrhythmias
Therapy of Older Persons With Ventricular Arrhythmias Therapy of Older Persons With Ventricular Arrhythmias Wilbert S. Aronow, MD, CMD Ventricular arrhythmias (VA) in asymptomatic older persons without heart disease should not be treated with antiarrhythmic drugs. Table III shows the effect of Class III antiarrhythmic drugs on mortality in persons with heart disease.54-58 None of the Class III antiarrhythmic drugs has been demonstrated in a double-blind, randomized, placebo-controlled ...
Testosterone Replacement in the Elderly: A Clinical Approach
Side Effects of Testosterone Replacement The most important possible side effect of T replacement in elderly men is exacerbation of prostate disease. It seems logical that in elderly men with clinical symptoms suggestive of androgen deficiency and subnormal testosterone levels, T replacement will result in increased muscle mass and strength, BMD, and a general sense of well-being. Differential effects of oral estrogen versus oral estrogen-androgen replacement therapy on body composition in ...
Update on the Management of Hypothyroidism
In the Colorado Thyroid Disease Prevalence Study, over 25,000 patients were screened for thyroid disease and grouped as having euthyroidism, mild thyroid failure, or overt hypothyroidism (Figure 2).4 All patients were evaluated for dyslipidemia, and while the cholesterol levels of patients with mild hypothyroidism were not as high as those with overt disease, there is definitely an elevation over the group with euthyroidism. The management goals for hypothyroidism in 2004 are to avoid ...
Mental illness and cardiovascular disease are seen both individually and concomitantly with significant frequency in the elderly, with two of the most prevalent mental disorders being depression and psychosis. Proper pharmacologic treatment of both conditions using antidepressant and antipsychotic agents includes an understanding of various pharmacokinetic and pharmacodynamic considerations (eg, drug absorption, distribution, metabolism, excretion), as well as the direct effect these agents may have on elderly persons, who are often more sensitive to the therapeutic effects as well as the adverse effects of these drugs. Cardiotoxic effects (such as QT interval prolongation), increased cerebrovascular events, metabolic dysfunction, and increased risk of death have been attributed to some of these medications. The coadministration of psychoactive and cardiovascular-related medications is also common in this population, and adds particular complexity to the task of choosing an appropriate drug regimen that provides maximum clinical efficacy with minimal drug-drug interaction. Both older and newer generations of agents will be discussed here. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[5]:34-45)
Arch Intern Med 2004;164:55-60. ADDITIVE BENEFITS OF PRAVASTATIN AND ASPIRIN TO DECREASE RISKS OF CARDIOVASCULAR DISEASE Randomized trials of secondary prevention have shown pravastatin sodium and aspirin to reduce the risk of cardiovascular disease. It is suggested that health care providers should use the Vaccine Information Sheets developed by the Centers for Disease Control and Prevention to inform patients about the risks and benefits associated with the influenza and pneumococcal ...
Abstracts from Medical Literature for the Geriatrics Practitioner Abstracts from Medical Literature for the Geriatrics Practitioner Click here to download full article in PDF THE QUEST FOR NURSING HOME QUALITY The most criticized sector of the U.S. health care system are nursing homes. : EFFECT OF SUBCLINICAL CARDIOVASCULAR DISEASE Recent studies have shown cardiovascular diseases to be the primary cause of death in older adults. According to age-stratified summaries, younger subjects with ...
It is well established that diabetes prevalence in the United States has reached an epidemic level and continues to increase. As the risk for diabetes increases with age, the importance of screening for diabetes among older patients is critical. Once diagnosed, diabetes in older persons must be managed on an individualized basis, according to the underlying comorbidities, level of functioning, and life expectancy of the patient. The health status of patients in older populations varies considerably; for many patients with a higher functional status, tight glycemic control is appropriate. Because these patients can benefit greatly from intensive therapy, it is important to identify and treat these older individuals without unnecessary delay. Treatment to glycemic targets eventually may require insulin therapy, either in combination with oral agents or alone in regimens that approach physiologic insulin secretion (ie, basal-prandial regimens). Caregivers should consider carefully the risks and benefits of insulin therapy for older patients with diabetes on a case-by-case basis, because insulin can safely provide the level of efficacy needed to reach and maintain glycemic targets for many patients. (Annals of Long-Term Care: Clinical Care and Aging 2007;14[11]:17-24)
This study examined the prevalence of prostate cancer among men in the Prostate Cancer Prevention Trial who had a PSA level of 4.0 ng/mL or less. The outcomes evaluated included total mortality, CHD mortality, nonfatal myocardial infarction, revascularization, and total CHD events. For women with known cardiovascular disease, treatment of hyperlipidemia is effective in reducing CHD events, CHD mortality, nonfatal myocardial infarction, and revascularization, but it does not affect total ...
Lower gastrointestinal (GI) bleeding is an important cause of increased morbidity and mortality in the elderly. Its incidence increases with age and corresponds to the increased incidence of specific GI diseases more common in the elderly, comorbid illnesses, and polypharmacy. GI illnesses associated with lower GI bleeding that are more common in the elderly include diverticulosis coli, vascular ectasia, ischemic colitis, and colonic neoplasms. Comorbid illnesses include atherosclerotic cardiovascular disease, cerebrovascular disease, and malignancy. The evaluation of patients is adjusted to the rate and severity of hemorrhage and the clinical status of the patient. The physical examination may be complicated by the presence of visual, auditory, and cognitive impairment. Timing of tests and the type of intervention should be custom-tailored, especially for the frail elderly patient. With appropriate evaluation and management, a successful outcome can be achieved in the majority of elderly patients with lower GI bleeding. (Annals of Long-Term Care: Clinical Care and Aging 2007;15[4]:40-45)
Persons with peripheral arterial disease (PAD) are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease (CAD). Modifiable risk factors such as cessation of cigarette smoking and control of dyslipidemia, hypertension, and diabetes should be treated. Statins decrease the incidence of intermittent claudication and improve exercise duration, as well as reduce cardiovascular events and mortality in persons with PAD and hypercholesterolemia. Antiplatelet drugs and angiotensin-converting enzyme inhibitors should be administered to all persons with PAD. Beta-blockers should be given if CAD is present. Exercise rehabilitation programs and cilostazol improve exercise time until intermittent claudication. Indications for lower-extremity angioplasty or bypass surgery include incapacitating claudication, limb salvage in persons with limb-threatening ischemia, and impotence of vascular origin. Amputation should be performed if tissue loss has progressed beyond the point of salvage, if surgery is too risky, if life expectancy is very short, or if functional limitations reduce the benefit of limb salvage. (Annals of Long-Term Care: Clinical Care and Aging 2005;13[9]: 35-40)
Therapy of Older Persons With Ventricular Arrhythmias Therapy of Older Persons With Ventricular Arrhythmias Wilbert S. Aronow, MD, CMD Ventricular arrhythmias (VA) in asymptomatic older persons without heart disease should not be treated with antiarrhythmic drugs. Table III shows the effect of Class III antiarrhythmic drugs on mortality in persons with heart disease.54-58 None of the Class III antiarrhythmic drugs has been demonstrated in a double-blind, randomized, placebo-controlled ...
Side Effects of Testosterone Replacement The most important possible side effect of T replacement in elderly men is exacerbation of prostate disease. It seems logical that in elderly men with clinical symptoms suggestive of androgen deficiency and subnormal testosterone levels, T replacement will result in increased muscle mass and strength, BMD, and a general sense of well-being. Differential effects of oral estrogen versus oral estrogen-androgen replacement therapy on body composition in ...
In the Colorado Thyroid Disease Prevalence Study, over 25,000 patients were screened for thyroid disease and grouped as having euthyroidism, mild thyroid failure, or overt hypothyroidism (Figure 2).4 All patients were evaluated for dyslipidemia, and while the cholesterol levels of patients with mild hypothyroidism were not as high as those with overt disease, there is definitely an elevation over the group with euthyroidism. The management goals for hypothyroidism in 2004 are to avoid ...