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Clinical manifestations and diagnosis of coronary artery disease
1Medical College of Wisconsin, Milwaukee, USA.
Insights
Coronary atherosclerosis is highly prevalent in older adults, often remaining asymptomatic. Early diagnosis of coronary heart disease (CHD) in the elderly is frequently missed due to atypical symptoms and co-existing conditions.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pathology
Background:
- Coronary atherosclerosis affects at least 70% of individuals over 70.
- Coronary heart disease (CHD) manifests clinically in 20-30% of those over 65.
- Disease presentation in the elderly can be silent or atypical.
Purpose of the Study:
- To highlight the prevalence of coronary atherosclerosis in the elderly.
- To address the challenges in diagnosing CHD in older populations.
- To explore reasons for misdiagnosis or underdiagnosis of CHD in seniors.
Main Methods:
- Review of autopsy studies on elderly populations.
- Analysis of clinical data for coronary heart disease manifestations in individuals over 65.
- Comparison of clinical presentations in elderly versus younger patients.
Main Results:
- Autopsy studies reveal high prevalence (≥70%) of coronary atherosclerosis in those >70 years.
- A significant percentage (20-30%) of individuals >65 years exhibit clinical CHD.
- Diagnosis is often delayed or incorrect due to atypical symptoms and comorbidities.
Conclusions:
- Coronary atherosclerosis is a widespread condition in the elderly.
- Atypical clinical manifestations and confounding factors complicate CHD diagnosis in older adults.
- Improved diagnostic strategies are needed to address underdiagnosis in this demographic.
Abstract:
Coronary atherosclerosis is very common in the elderly population with autopsy studies demonstrating the prevalence to be at least 70% in persons over the age of 70. These autopsy findings may be coincidental, with the disease clinically silent throughout the person's life, although 20% to 30% of persons over age 65 years will demonstrate clinical manifestations of coronary heart disease (CHD). In most elderly persons, the disease will have manifested itself much earlier in their lives, however, in others the disease will be entirely silent until the person reaches his or her 70s or 80s. Unfortunately, even though CHD is prevalent in elderly persons, the disease is often not diagnosed or misdiagnosed in this age group. Failure to correctly diagnose the disease in the elderly may be due to the difference in the clinical manifestation in this age group compared with younger patients. Such differences may reflect a difference in the disease process between older and younger patients or it may be related to the superimposition of normal aging changes, plus the presence of concomitant diseases, which may mask the usual clinical manifestations.