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The world population in both industrialized and developing countries is aging. For example, in the United States, 35 million people are over the age of 65 years, and the number of older Americans is expected to double by the year 2030. The clinical and economic implications of this demographic shift are staggering because age is the most powerful risk factor for cardiovascular diseases (CVDs). The...
The 20th century witnessed an historical change in the landscape of human evolution as the limits of human longevity pressed ever upward in advanced cultures. At the outset of the 20th century, average longevity in America barely exceeded 48 years and only 3% of the population was over the age of 65. This reflected the underdeveloped status of our nation at that time, when public health measures were...
One of the most important reasons for the decline in age-adjusted cardiovascular mortality is the identification and treatment of reversible cardiac risk factors. However, until recently, most clinical studies evaluating the efficacy of these interventions excluded elderly individuals. Although the pathological process that results in coronary atherosclerosis begins with the development of fatty streaks...
History and physical examination as well as an electrocardiogram (EKG) should be obtained in all patients with suspected coronary artery disease (CAD). American College of Cardiology/American Heart Association (ACC/AHA) guidelines also recommend checking hemoglobin, fasting blood glucose, and a fasting lipid panel in new patients presenting with angina (1). Co-morbid conditions that may precipitate...
Advanced age is a powerful independent predictor of in-hospital and subsequent mortality and morbidity in patients following an ST-elevation myocardial infarction (MI) (1–4). Randomized studies including thousands of patients with ST-segment elevation MI indicate 10-fold increases in death, clinical heart failure, and cardiogenic shock following either thrombolytic or primary angioplasty as age increases...
Ischemic heart disease is the leading cause of morbidity and mortality for adults in the Western world. Approximately 1.4 million patients are admitted to US hospitals for unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI) (1). Of patients admitted to US hospitals for MI, 37% are 75 years of age or older (2). When compared to younger patients with acute coronary syndrome (ACS),...
Cardiovascular disease (CVD) has been the number one cause of death each year in America since 1900, except for 1918, the year of the Spanish flu pandemic. As the population—particularly the baby-boomer generation—ages, this statistic is unlikely to change. The segment of the population that is older than age 80 is growing more rapidly and is living longer than age-matched populations from the late...
The elderly population is the most rapidly expanding sector of the US population, with an estimated 13 million citizens over the age of 75, including 1.6 million nonagenarians and 72,000 centenarians; these figures are expected to quadruple over the next half century (1). Based on population studies, life expectancy at the age of 80 years is 8.5 years, and at the age of 85 and over, it is 6.3 years...
Heart failure (HF) affects approximately 5 million Americans, and more than 550,000 new cases are reported each year (1,2). In addition, despite recent advances in the diagnosis and treatment of HF, as well as reductions in age-adjusted mortality rates from coronary heart disease and hypertensive cardiovascular disease (CVD) (3,4), both the incidence and prevalence of HF are increasing, primarily...
Valvular disease continues to be an important cause of morbidity and mortality across the globe with an increasing number of elderly patients affected by “degenerative” valvular diseases on top of a background incidence of unrecognized rheumatic and infective endocarditis (1–3). Although there are no recent population-based data regarding the prevalence of valvular heart disease in the elderly, several...
Arrhythmias cause significant mortality and impair quality of life in the elderly. The prevalences of cardiac arrhythmias and disorders of impulse formation and conduction, increase with age (1,2). As the US population ages and as cardiovascular care for coronary disease and heart failure improves, the prevalence and burden of electrophysiological disorders will continue to rise. In fact, among Medicare...
Peripheral arterial disease (PAD) is most commonly caused by atherosclerotic lesions developing in the intimal region of arteries in the lower and upper extremities. The term also includes patients with aortoiliac disease. Claudication, the Latin word for limp, denotes pain or discomfort in a specific muscle group of an extremity with exercise and occurs in approximately one-third of patients with...
“Cardiac rehabilitation services are comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. These programs are designed to limit the physiologic and psychologic effects of cardiac illness, reduce the risk for sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process,...
Advancing age and disease can alter pharmacokinetic processes that determine drug concentration and pharmacodynamic processes that determine drug concentration vs response relationships. The frequency of cardiovascular disorders of hypertension, coronary artery disease (CAD), cerebrovascular disease, atrial fibrillation, heart failure, and peripheral vascular diseases increases with age, as does the...
All life ends. This is life’s only certainty. Fifty years ago, a family of five saw a loved one die and people accepted the biblical unalterable truth that there is a time for everything under heaven … a time to be born and a time to die.
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