Dr. Maria Angeles Alonso Garcia
The number of elderly patients with cardiovascular disease is rapidly increasing, mainly due to better treatment and improved survival of cardiac disease. Also of importance is the ageing population in most European countries. Elderly patients with cardiovascular disease may require specific drug treatment. However, cardiovascular drugs are often not well studied in the elderly. This symposium organised together by the European Society of Cardiology and the International Society of Cardiovascular Pharmacotherapy addressed the evidence for treatment of common cardiovascular disorders in the elderly.
Hypertension in the elderly is very common. Randomized controlled studies have shown the benefit of antihypertensive treatment in elderly patients up to at least 85 years of age. The benefit is rapid in terms of reduction of stroke, heart failure and total mortality. Blood pressure reduction is likely more important than the drug class used. The current therapy armamentarium for treating hypertension can be used in old patients, individualizing the doses, and especially monitoring orthostatic hypotension
In heart failure, existing data suggest that elderly patients should be treated similar to younger patients, although this is not well studied. However, more careful titration to the highest tolerable of dose of blockers of the renin-angiotensin aldosterone system and beta blockers is advised as side effects may be more common in the elderly heart failure patient.
The expanding use of combination antithrombotic therapy and anticoagulant therapy in the treatment of an acute coronary syndrome is a major challenge in the elderly, who are at increased risk of bleeding complications. Unfortunately, many recently introduced drugs have not been well studied in elderly patients. It is important to reduce the risk of bleeding complications by using clinical judgement and avoiding unjustified prolonged drug exposition and drug combinations with anticipated greater risk for bleeding complications. Triple therapy with dual antiplatelet therapy and anticoagulation should be avoided as much as possible.
Although the benefit of lipid lowering drugs is well established, the relative risk reduction appears reduced with increasing age. Thus, global risk assessment is important in the decision to treat the elderly patient with lipid lowering drugs. It may be reasonable to initiate lipid lowering drug therapy in high risk people up to approximately 90 years of age, although there is little direct evidence.
Can a patient be too old to receive cardiovascular drug treatment?
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