Scientific statement on secondary prevention of atherosclerotic disease in the elderly
Secondary Prevention of Atherosclerotic Cardiovascular Disease in Older Adults: A Scientific Statement From the American Heart Association
Fleg JL, Forman DE, Berra K, et al.
Circulation. October 28, 2013. doi: 10.1161/01.cir.0000436752.99896.22
Due to important developments since its first scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly, the American Heart Association considered it time for an update.
A growing aging population brings along a higher prevalence of CHD as well as peripheral artery disease (PAD). As a result of these demographic changes, atherosclerotic cardiovascular disease (ASCVD)-related healthcare costs are expected to rise. This underscores the need for effective secondary prevention measures in the elderly with known ASCVD.
Since the original publication of the scientific statement, a great number of randomised controlled trials that address secondary prevention of ASCVD have been added to the body of evidence. Although more trials have included larger numbers of older adults, they are still underrepresented in studies, with respect to their proportion in the population of people with ASCVD. The generalisability of the studies’ conclusions to typical older patients remains problematic. A large proportion of older patients who are eligible for treatment of ASCVD and its risk factors according to published guidelines, are not receiving evidence-based therapies.
This update therefore aimed to clarify the benefits and risks of secondary prevention interventions in older adults. The AHA hopes to stimulate an improved application of proven secondary prevention therapies in older patients with CHD and the broader spectrum of atherosclerotic vascular disease.
The main goals of secondary prevention of ASCVD are to prevent or delay the progression of disease, that may progress to major clinical events, thereby likely improving longevity and quality of life, and limiting health care costs.
The document outlines the available evidence on therapeutic preventive strategies in patients over 65 years old, and where available on those ages >75 years. Specific attention is given to age-related physiological changes and comorbidites that commonly complicate care of the elderly.
The risk-to-benefit ratios of pharmacological, invasive and lifestyle preventive strategies vary with age. More insight is needed on which senior patients with ASCVD are likely to benefit from secondary prevention therapy. It is essential to include older and very elderly patients in clinical trials, to expand knowledge on the complicating factors of care in the elderly and to improve risk assessment. This will aid in providing better care, in line with realistic advantages, burden and limitations of care, and naturally, each individual patients’ goals and perceived quality of life.
Fleg JL, Forman DE, Berra K, et al. Secondary Prevention of Atherosclerotic Cardiovascular Disease in Older Adults: A Scientific Statement From the American Heart Association. Circulation. Originally published October 28, 2013. doi: 10.1161/01.cir.0000436752.99896.22