Secondary cardiovascular prevention in older adults: an evidence based review.

Abstract

1 Background In the United States, life expectancy is rising, particularly among the older population (≥ 65 years), with projected estimates approaching 20% by year 2050. (1) Despite im- proved survival estimates, cardiovascular diseases remain the leading cause of morbidity and mortality resulting in substantial increase in health care cost. (2) For younger adults, the evidence for secondary cardiovascular prevention is well established and corroborated by robust data. However, the application of risk reduction strategies in older populations remains an area of active debate. Many assume that vulner- ability to chronic cardiovascular diseases is an inexorable part of aging such that the risks attributable to prevention outweigh potential benefits. Yet, while aging is associated with greater predisposition to disease, the onset and pro- gression of cardiovascular disorders may still be modified by effective risk reduction strategies, which may ultimately improve survival as well as symptoms, quality of life, and functional independence. If such improvements are achiev- ed, it may potentially offset the rising healthcare costs asso- ciated with cardiovascular morbidity as well as related vul- nerabilities to frailty, disability, and enfeeblement. In this review, we will discuss current available evidence for sec- ondary cardiovascular prevention in the elderly. aged 65 years or older had a BMI > 30 kg/m 2 . Among adults aged 75 years or older, 27.8% were obese and 33% were found to be overweight. (3) Lower metabolic rates, decreased physical activity, and difficult-to-change dietary habits are potential risk factors that contribute to the development of obesity among the elderly. Although obesity can theoreti- cally compound the risk of atherosclerotic disease and wor- sen co- existing co-morbidities like diabetes and hypertension, it also begets other comorbid conditions, such as arthritis, restricted respiratory function, urinary incontinence, and can even increase the risk of certain cancers among older adults. (4) Despite these associations, there is lack of strong evi- dence suggesting that weight reduction among the elderly decreases all-cause-mortality. In fact, controversies exist regarding whether elevated BMI may be associated with lower mortality rates, which formed the basis for the obe- sity-survival paradox.