cardiovascular diseases in elderly, ischemic heart disease, hypertension, dyslipidemia, heart failure

1. Cardiovascular
diseases in Elderly
Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI,
FAPSC, FAPSIC, FAHA, FCCP, FRCPG
Associate Professor of Cardiology
National Institute of Cardiovascular Diseases(NICVD),
Sher-e-Bangla Nagar, Dhaka-1207
Consultant, Medinova, Malibagh branch
Honorary Consultant, Apollo Hospitals, Dhaka and
STS Life Care Centre, Dhanmondi
drtoufiq19711@yahoo.com
CRT 2014
Washington
DC, USA

2. Introduction
• Cardiovascular disease is the most frequent diagnosis in
elderly people and is the leading cause of death in both
men and women older than 65 years of age.
• Hypertension occurs in one half to two thirds of people
older than 65 years of age, and heart failure (HF) is the
most frequent hospital discharge diagnosis among older
Americans.
• The profile of these common cardiovascular diseases
differs in older patients from that in younger patients.
• Systolic, but not diastolic, blood pressure increases with
aging, resulting in increased pulse pressure.
• Systolic hypertension becomes a stronger predictor of
cardiovascular events, especially in women.
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3. • Heart failure with preserved systolic function becomes
more common at older ages and is more common in
women.
• Coronary artery disease (CAD) is more likely to involve
multiple vessels and left main artery disease and is equally
likely in women as in men older than 65 years of age.
• Equal numbers of older men and women present with
acute myocardial infarction (MI) until age 80, after which
more women present.
• More than 80 percent of all deaths attributable to
cardiovascular disease occur in people older than 65 years
with approximately 60 percent of deaths in patients older
than 75 years.
Introduction
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4. Prevalence of cardiovascular and other common chronic medical illnesses in older persons in
the United States. Data are percentages. 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. AF = atrial fibrillation; CAD = coronary artery disease; CVD =
cardiovascular disease; HF = heart failure; BP = hypertension (all forms); PAD = peripheral
artery disease.drtoufiq19711@yahoo.com

5. U.S. population estimates projected from 2000 until 2050. Dark pink bars
represent numbers of women older than 65 years. Dark blue bars represent men
older than 65 years. Light pink bars represent numbers of women older than 85
years. Light blue bars represent numbers of men older than 85 years in millions
of people
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6. Prevalence of cardiovascular and other common chronic medical illnesses in
older persons in the United States. Data are percentages. 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. AF =
atrial fibrillation; CAD = coronary artery disease; CVD = cardiovascular disease;
HF = heart failure; BP = hypertension (all forms); PAD = peripheral artery
disease.

7. Differentiation Between Age-Associated Changes
and Cardiovascular Disease in Older People
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8. Estimated Glomerular Filtration Rate (eGFR) by
Age, Sex, and Race
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9. Guidelines for Medication Prescribing in Older Patients
• In general, loading doses should be reduced—weight (or body surface
area) can be used to estimate loading dose requirements; doses in women
are usually less than in men.
• Use estimates of glomerular filtration to guide dosing of renally cleared
medications and contrast administration; reduce doses of metabolically or
hepatically cleared drugs.
• Time between dosage adjustments and evaluation of dosing changes
should be longer in older patients than younger patients.
• Routine use of strategies to avoid drug interactions is essential—
incorporating reference materials, a team approach, and quality
improvement initiatives are effective strategies.
• Knowledge of effects of noncardiac medications is necessary.
• Assessment of adherence and attention to factors contributing to
nonadherence should be part of the prescribing process.
• Physicians must be familiar with the patient's source of prescription
medication coverage including Medicare D legislation and provide patient
education and assistance with obtaining critical medications.
• Multidisciplinary approaches to monitoring medication therapy may
increase successful outcomes of medication therapy.
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10. The relationship between the number of drugs consumed and drug
interactions. Current guidelines for the pharmacological management
of patients with heart failure (HF) or myocardial infarction (post MI)
place them at high risk for drug interactions.
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11. Estimation of 4-Year Mortality in the Elderly
Using Medical and Functional Information
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12. Thank Youdrtoufiq19711@yahoo.com
Asia Pacific Congress of
Hypertension, 2014, February
Cebu city, Phillipines
Seminar on Management
of Hypertension,
Gulshan, Dhaka