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Coronary heart disease risk factors in older persons
M C Corti1, J M Guralnik, C Bilato
1Epidemiology, Demography, Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA.
Insights
Coronary heart disease (CHD) risk factors are debated in older adults. While hypertension and smoking are proven risks, evidence for lipid abnormalities, obesity, and inactivity needs more clinical trial support in this age group.
Area of Science:
- Cardiology
- Geriatrics
- Epidemiology
Background:
- Coronary heart disease (CHD) is a leading cause of death and disability in Western nations, particularly among individuals over 65.
- The significance of traditional CHD risk factors is well-established in middle-aged populations but remains debated in older adults.
Purpose of the Study:
- To review epidemiologic evidence on established CHD risk factors in older men and women.
- To identify high-risk individuals and evaluate the effectiveness of risk factor modification for CHD prevention in the elderly.
Main Methods:
- Review of epidemiologic evidence from observational studies.
- Analysis of randomized clinical trials concerning CHD risk factors in older populations.
- Consideration of factors like comorbidity, frailty, and age-related changes.
Main Results:
- Hypertension and cigarette smoking are clearly associated with increased CHD risk and effective for prevention in older persons.
- Observational studies suggest lipid abnormalities, obesity, and physical inactivity are associated with CHD risk, but clinical trial evidence is limited.
- The role of estrogen replacement therapy in older women requires further investigation.
Conclusions:
- Modification of hypertension and smoking is crucial for CHD prevention in older adults.
- Further research, including clinical trials, is needed to confirm the benefits of modifying other risk factors in the elderly.
- Holistic evaluation considering comorbidities and other health outcomes is essential when managing risk factors in older individuals.
Abstract:
In most Western nations, coronary heart disease (CHD) is the leading cause of death and one of the most important causes of physical disability in persons over 65 years of age. The importance of traditional CHD risk factors has been well documented in middle-aged populations, whereas their role in older populations is still under debate. This paper reviews the epidemiologic evidence from observational studies and randomized clinical trials that established risk factors for CHD predict level of risk of CHD, and identify high risk individuals among older men and women. Hypertension and cigarette smoking have been clearly associated with an increased risk of CHD events, and their modification has been proven to be highly effective in the primary and secondary prevention of CHD in older persons. For other highly prevalent risk factors, such as lipid abnormalities, obesity and physical inactivity, evidence of an independent association with CHD risk has been demonstrated by the majority of observational studies. However, definitive proof from controlled clinical trials of the beneficial effects of their modification is still lacking in the older population. The role of estrogen replacement therapy in the primary and secondary prevention of CHD in old women is still an open question. In evaluating the impact of these risk factors in older persons, elements such as comorbidity, frailty, and age-related changes in risk profile should also be taken into consideration. Given the complexity of the relationship between risk factors and multiple disease statuses, other important outcomes, such as osteoporosis, cancer, falls and physical disability, should be considered when evaluating the risks and benefits of risk factor modifications in older persons.