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Table 135.1  --  Effects of aging on the cardiovascular system .

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Table 135.1  --  Effects of aging on the cardiovascular system .

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  1. FIGURE 80-1United States population estimates projected from 2000 until 2050. Dark pink bars represent numbers of women older than 65 years, and dark blue bars represent numbers of men older than 65 years; lighter pink bars represent numbers of women older than 85 years, and lighter blue bars represent numbers of men older than 85 years in millions of people.)Source: U.S. Census Bureau.(

  2. FIGURE 80-2Prevalence of cardiovascular and other common chronic medical illnesses in older persons in the United States. Data are percentages. AF = atrial fibrillation; CAD = coronary artery disease; CVD = cardiovascular disease; HF = heart failure; high BP = hypertension (all forms); PAD = peripheral artery disease. Blue bars represent data for men older than 65 years, pink bars represent women older than 65 years, and yellow bars represent men and women older than 80 years

  3. Table 135.1 -- Effects of aging on the cardiovascular system.

  4. Modified from Stolker JM, Rich MW. Diagnosis and management of heart disease in the elderly. In Arenson C, Reichel W, eds. Reichel's Care of the Elderly. 6th ed. Lippincott Williams & Wilkins, 2009.

  5. Figure 135.1Prevalence of cardiac disease by age and gender. Prevalence of cardiovascular diseases (including coronary heart disease, heart failure, stroke, and hypertension) by age and gender in the United States, 1999 to 2002

  6. Table 135.2 -- Effects of aging on other organ systems Modified from Stolker JM, Rich MW. Diagnosis and management of heart disease in the elderly. In Arenson C, Reichel W, eds. Reichel's Care of the Elderly. 6th ed. Lippincott Williams & Wilkins, 2009.

  7. Figure 135.2VO2 max as a function of age and gender. Peak treadmill oxygen consumption (VO2 max) as a function of age and gender in healthy subjects.

  8. Figure 135.3Annual rate of first heart attack. Annual rate of first heart attack by age, gender, and race in the Atherosclerosis Risk in Communities (ARIC) study, 1987 to 2000.

  9. Figure 135.4Clinical presentation of acute myocardial infarction in elderly patients. Clinical presentation of acute myocardial infarction in patients age 85 or older

  10. Figure 135.5Prevalence of atrial fibrillation by age and gender. Prevalence of atrial fibrillation by age and gender in a large health maintenance organization, 1996 to 1997.

  11. Figure 135.8Benefits of invasive therapy for the elderly. Benefits of invasive therapy for elderly subjects with non-ST-elevation acute coronary syndromes enrolled in the TACTICS-TIMI 18 trial.

  12. FIGURE 80-3Directly measured arterial waveforms from a peripheral artery (radial) and calculated aortic pressure waves for a young man aged 26 years in the upper panels and his 83-year-old grandfather in the lower panels.)Courtesy of Michael O’Rourke, MD, University of Sydney, Australia.(

  13. TABLE 80-1Differentiation Between Age-Associated Changes and Cardiovascular Disease in Older People

  14. TABLE 80-2 -- Guidelines for Medication Prescribing in Older Patients

  15. FIGURE 80-6The relationship between the number of drugs consumed and drug interactions. Current guidelines for the pharmacologic management of patients with heart failure (HF) or myocardial infarction (post MI) place them at high risk for drug interactions.)From Schwartz JB: Clinical Pharmacology, ACCSAP V, 2003. As modified from Nolan L, O’Malley K: The need for a more rational approach to drug prescribing for elderly people in nursing homes. Age Aging 18:52, 1989; and Denham MJ: Adverse drug reactions. Br Med Bull 46:53, 1990.(

  16. TABLE 80-4 -- Considerations for Pharmacologic Therapy for Older Patients with Hypertension and Other Disorders

  17. ACE = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; COPD = chronic obstructive pulmonary disease; NSAIDs = nonsteroidal anti-inflammatory drugs; DHP = dihydropyridine; SSRI = selective serotonin reuptake inhibitor.*Recommendations for second-line agents usually added to thiazide diuretics from Chobanian AV, Bakris GL, Black HR, et al: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 289:2560, 2003.†Mancia G, De Backer G, Dominiczak A, et al: 2007 Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 28:1462, 2007.‡Only available transdermal formulation for patients unable to swallow or who refuse oral medications.?Systolic heart failure only.∥Norgren L, Hiatt W, Dormandy J, et al: Inter-Society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 45:S5A, 2007.?Nursing home patients.

  18. Systolic as well as diastolic hypertension should be treated; current recommendations are based on brachial artery measurements: Patients should be monitored for adverse effects and drug interactions, especially TABLE 80-5 -- Approach to Hypertension in Older Patients Current Controversies Table 80-5summarizes the approach to hypertension in older patients

  19. FIGURE 80-8In-hospital mortality rates reported for revascularization procedures by age group. PCI = percutaneous coronary intervention of all types; CABG = coronary artery bypass graft surgery. (Data are from the National Cardiovascular Revascularization Network as reported by Alexander K, Anstrom K, Muhlbaier L, et al: Outcomes of cardiac surgery in patients ≥80 years: Results from the National Cardiovascular Network. J Am Coll Cardiol 35:731, 2000; Batchelor W, Anstrom K, Muhlbaier L, et al: Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: Results in 7,472 octogenarians. National Cardiovascular Network Collaboration. J Am Coll Cardiol 36:723, 2000; and the Society of Thoracic Surgeons data base, Bridges C, Edwards F, Peterson E, et al: Cardiac surgery in nonagenarians and centenarians. J Am Coll Cardiol 197:347, 2003.)Data were not available for PCI in patients older than 90 years. See text for further discussion of results for drug-eluting stents and newer surgical approaches.

  20. FIGURE 80-5Estimates of creatinine clearance with the Cockcroft and Gault formula(left panel)and estimates of glomerular filtration rate with the MDRD simplified algorithm(right panel)for men and women aged 45 to 85 years. For calculations, mean weight and height by decade were obtained from U.S. survey data (NHANES, http://www.cdc.gov ); serum creatinine is 1.0 mg/dL (average for older than 65 years in NHANES). Pink lines and circles represent estimates for women; blue lines and diamonds are estimates for men; lighter symbols are estimates for whites, and darker symbols represent estimates for African Americans. The shaded areas indicate GFR estimates of 30 to 59 mL/min/m2 classified as stage 3 renal disease or moderate GFR decrease. Cockcroft and Gault estimates show a steeper decline with age. Both formulas estimate lower clearance in women compared with men and higher clearances in African Americans compared with whites (based on average height and weights and the same creatinine concentration).(Modified from Schwartz JB: The current state of knowledge on age, sex, and their interactions on clinical pharmacology

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