Primary Prevention of Cardiovascular Risk in Octogenarians by Risk Factors Control

Author(s): Pasquale Palmiero* , Annapaola Zito , Maria Maiello , Annagrazia Cecere , Anna Vittoria Mattioli , Roberto Pedrinelli , Pietro Scicchitano , Marco Matteo Ciccone .

Journal Name: Current Hypertension Reviews

Volume 15 , Issue 2 , 2019

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Abstract:

Primary prevention of cardiovascular events in older adults is a relevant problem, due to lack of evidence for safe and efficacious therapy, its costs and elderly quality of life, Italy’s aging population is constantly increasing, so cardiovascular disease (CVD) primary prevention in the elderly is a prime objective. Life expectancy has dramatically increased over the last 2 decades, the proportion of individuals aged 80 years and older has grown rapidly in Europe and the United States, but cost / effective ratio of CVD prevention through risk factors control is debated. It is therefore important to implement cardiovascular risk factors estimation in the elderly to maximize the quality of life of patients and to lengthen their healthy life expectancy, choosing the better treatment for each patient sharing the choice with himself when it is possible, always remembering that elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of CVD prevention therapy. Nevertheless, CVD is not an inevitable concomitant of aging. Sometimes, autopsy in the elderly reveals atheroma-free coronary arteries, a normal-sized heart and unscarred valves. All primary prevention strategy decisions should consider estimated life expectancy and overall function and not just the cardiovascular event risks, magnitude and time to benefit or harm, potentially altered adverse effect profiles, and informed patient preferences. CVD primary prevention needs to be more implemented in the elderly, this might contribute to improve health status and quality of life in this growing population if correctly performed.

Keywords: Primary prevention, cardiovascular risk, octogenarians, risk factors control, hypertension.

[1]
Administration on Aging. A Profile of Older Americans. Washington, DC: U.S. Department of Health and Human Services. Government Printing Office 2000.
[2]
Barry AR, O’Neill DE, Graham MM. Primary prevention of cardiovascular disease in older adults. Can J Cardiol 2016; 32(9): 1074-81.
[3]
Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation 2003; 107: 2864-9.
[4]
Dregan A, Ravindrarajah R, Hazra N, Hamada S, Jackson SH, Gulliford MC. Longitudinal trends in hypertension management and mortality among octogenarians: Prospective cohort study. Hypertension 2016; 68: 97-105.
[5]
Staessen JA, Gasowski J, Wang JG, et al. Risks of untreated and treated isolated systolic hypertension in the elderly: Meta-analysis of outcome trials. Lancet 2000; 355: 865-72.
[6]
Beckett NS, Peters R, Fletcher AE, et al. HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887-98.
[7]
Williamson JD, Supiano MA, Applegate WB, et al. SPRINT Research Group. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: A randomized clinical trial. JAMA 2016; 315: 2673-82.
[8]
Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA. Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American Academy of Family Physicians. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med 2017; 166(6): 430-7.
[9]
Weiss J, Freeman M, Low A, et al. Benefits and harms of intensive blood pressure treatment in adults aged 60 years or older. A systematic review and meta-analysis. Ann Intern Med 2017; 166: 419-29.
[10]
Pignone M, Viera AJ. Blood pressure treatment targets in adults aged 60 years or older. Ann Intern Med 2017; 166(6): 445-6.
[11]
Bahat G, İlhan B, Tufan A, Karan MA. Blood pressure goals in functionally limited elderly patients. Am J Med 2017; 130: e319-20.
[12]
Benetos A, Bulpitt CJ, Petrovic M, et al. An expert opinion from the European Society of Hypertension–European Union Geriatric Medicine Society Working Group on the Management of Hypertension in Very Old, Frail Subjects. Hypertension 2016; 67: 820.
[13]
Benetos A, Labat C, Rossignol P, et al. Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: The PARTAGE study. JAMA Intern Med 2015; 175: 989-95.
[14]
Fouge’re B, Kelaiditi E, Hoogendijk EO, et al. Frailty index and quality of life in nursing home residents: Results from INCUR Study. J Gerontol A Biol Sci Med Sci 2016; 71: 420-4.
[15]
Hajjar I, Rosenberger KJ, Kulshreshtha A, Ayonayon HN, Yaffe K, Goldstein FC. Association of JNC-8 and SPRINT systolic blood pressure levels with cognitive function and related racial disparity. JAMA Neurol 2017; 74(10): 1199-205.
[16]
LeMatire RN, Furberg CD, Newman AB, et al. Time trends in the use of cholesterol-lowering agents in older adults: The Cardiovascular Health study. Arch Intern Med 1998; 158: 1761-8.
[17]
Curb JD, Abbott RD, Rodriguez BL, et al. Prospective association between low and high total and low-density lipoprotein cholesterol and coronary heart disease in elderly men. J Am Geriatr Soc 2004; 52: 1975-80.
[18]
Vergani C, Lucchi T, Caloni M, et al. I405V polymorphism of the cholesteryl ester transfer protein (CETP) gene in young and very old people. Arch Gerontol Geriatr 2006; 43: 213-21.
[19]
Morley JE. The cholesterol conun drum. J Am Geriatr Soc 2011; 59: 1955-6.
[20]
Lewington S, Whitlock G, Clarke R, et al. Prospective Studies Collaboration. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55 000 vascular deaths. Lancet 2007; 370: 1829-39.
[21]
Goldstein JL, Hazzard WR, Schrott HG, Bierman EL, Motulky AG. Hyperlipidemia in coronary heart disease. I. Lipid levels in 500 survivors of myocardial infarction. J Clin Invest 1973; 52: 1533-43.
[22]
Gordon DJ, Rifkind BM. Treating high blood cholesterol in the older patient. Am J Cardiol 1989; 63: 48H-52H.
[23]
Newson RS, Felix JF, Heeringa J, Hofman A, Witteman JC, Tiemeier H. Association between serum cholesterol and noncardiovascular mortality in older age. J Am Geriatr Soc 2011; 59: 1779-85.
[24]
Mangin D, Sweeney K, Heath I. Preventive health care in older people needs rethinking. BMJ 2007; 335: 285-7.
[25]
Abramson J, Wright J. Are lipid guide-77. lines evidence-based? Lancet 2007; 369: 168-9.
[26]
Gurwitz JH, Go AS, Fortmann SP. Statins for primary prevention in older adults: uncertainty and the need for more evidence. JAMA 2016; 316(19): 1971-2.
[27]
Savarese G, Gotto AM Jr, Paolillo S, et al. Benefits of statins in elderly subjects without established cardiovascular disease: A meta-analysis. J Am Coll Cardiol 2014; 63(11): 1122.
[28]
Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J 2016; 37(39): 2999-3058.
[29]
Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2011. Atlanta, Georgia: U.S. Department of Health and Human Services 2011.
[30]
Brown AF, Mangione CM, Saliba D, Sarkisian CA. California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc 2003; 51(Suppl. Guidelines): S265-80.
[31]
Sinclair AJ, Paolisso G, Castro M, Bourdel MI, Gadsby R, Rodriguez ML. European Diabetes Working Party for Older People. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab 2011; 37(Suppl. 3): S27-38.
[32]
Incalzi RA, Ferrara N, Maggi S, Paolisso G, Vendemiale G. 2017- Position Statement SID-SIGG. Customization of the treatment of hyperglycemia in the elderly with type 2 diabetes. Bonora E, Giaccari A, Perseghin G, Purrello F, Roberto Miccoli GS. Eds. Societa Italiana di Diabetologia (SID) - Standard. 2017.
[33]
Ruggiero C, Cherubini A, Ble A, et al. Uric acid and inflammatory markers. Eur Heart J 2006; 27: 1174-81.
[34]
Maiuolo J, Oppedisano F, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol 2016; 213: 8-14.
[35]
Pasalic D, Marinkovic N, Feher-Turkovic L. Uric acid as one of the important factors in multifactorial disorders – facts and controversies. Biochem Med 2012; 22(1): 63-75.
[36]
Grassi D, Desideri G, Ferri C. New insight into urate related mechanism of cardiovascular damage. Curr Pharm Des 2014; 20(39): 6089-95.
[37]
Bardin T, Desideri G. How to manage patients with gout. Curr Med Res Opin 2013; 29(Suppl. 3): 17-24.
[38]
Terkeltaub RA. Clinical practice. Gout N Engl J Med 2003; 349: 1647-55.
[39]
Burnier M, Brunner HR. Renal effects of angiotensin II receptor blockade and angiotensin-converting enzyme inhibition in healthy subjects. Exp Nephrol 1996; 4(Suppl. 1): 41-6.
[40]
Cardillo C, Kilcoyne CM, Cannon RO III, et al. Xanthine oxidase inhibition with oxypurinol improves endothelial vasodilator function in hypercholesterolemic but not in hypertensive patients. Hypertension 1997; 30(1 Pt 1): 57-63.
[41]
Povoroznyuk VV, Dubetska GS. Hyperuricemia and age. Gerontologija 2012; 13(3): 149-53.
[43]
ISTAT. Popolazione. Italia in cifre edizione 2016. http://www. istat.it/it/archivio/popolazionee-famiglie
[44]
WHO. An overarching health indicator for the post-2015 development agenda. Brief summary of some proposed candidate indicators. Background paper for expert consultation, 11-12.
[45]
WHO. World Health Statistics 2016: Monitoring Health for The SDGS (Sustainable Development Goals) http://www.who.int/ gho/publications/world_health_statistics/2016/en/
[46]
Benziger CP, Roth GA, Moran AE. The global burden of disease study and the preventable burden of NCD. Glob Heart 2016; 11(4): 393-7.
[47]
Pedro-Botet J, Climent E, Chillarón JJ, Toro R, Benaiges D, Flores-Le Roux JA. Statins for primary cardiovascular prevention in the elderly. J Geriatr Cardiol 2015; 12(4): 431-8.
[48]
Kannel WB, Doyle JT, Shephard RJ, Stamler J, Vokonas PS. Prevention of cardiovascular disease in the elderly. J Am Coll Cardiol 1987; 10(2)(Suppl. A): 25A-8.
[49]
Schwartz JB. Primary prevention: Do the very elderly require a different approach? Trends Cardiovasc Med 2015; 25(3): 228-39.
[50]
Andrawes WF, Bussy C, Belmin J. Prevention of cardiovascular events in elderly people. Drugs Aging 2005; 22(10): 859-76.


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Article Details

VOLUME: 15
ISSUE: 2
Year: 2019
Page: [78 - 84]
Pages: 7
DOI: 10.2174/1573402115666190211160811

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