CARDIOVASCULAR DISEASE IN THE ELDERLY

Transcription

1 CARDIOVASCULAR DISEASE IN THE ELDERLY

2 CONTEMPORARY CARDIOLOGY CHRISTOPHER P. CANNON, MD SERIES EDITOR Cardiovascular Disease in the Elderly, edited by Gary Gerstenblith, MD, 2005 Platelet Function: Assessment, Diagnosis, and Treatment, edited by Martin Quinn, MB BCh BAO, PhD, and Desmond Fitzgerald, MD, FRCPI, 2005 Diabetes and Cardiovascular Disease, Second Edition, edited by Michael T. Johnstone, MD, CM, FRCP(C), and Aristidis Veves, MD, DSc, 2005 Angiogenesis and Direct Myocardial Revascularization, edited by Roger J. Laham, MD, and Donald S. Baim, MD, 2005 Interventional Cardiology: Percutaneous Noncoronary Intervention, edited by Howard C. Herrmann, MD, 2005 Principles of Molecular Cardiology, edited by Marschall S. Runge, MD, and Cam Patterson, MD, 2005 Heart Disease Diagnosis and Therapy: A Practical Approach, Second Edition, M. Gabriel Khan, MD, FRCP(LONDON), FRCP(C), FACC, 2005 Cardiovascular Genomics: Gene Mining for Pharmacogenomics and Gene Therapy, edited by Mohan K. Raizada, PhD, Julian F. R. Paton, PhD, Michael J. Katovich, PhD, and Sergey Kasparov, MD, PhD, 2005 Surgical Management of Congestive Heart Failure, edited by James C. Fang, MD and Gregory S. Couper, MD, 2005 Cardiopulmonary Resuscitation, edited by Joseph P. Ornato, MD, FAP, FACC and Mary Ann Peberdy, MD, FACC, 2005 CT of the Heart: Principles and Applications, edited by U. Joseph Schoepf, MD, 2005 Heart Disease and Erectile Dysfunction, edited by Robert A. Kloner, MD, PhD, 2004 Cardiac Transplantation: The Columbia University Medical Center/New York-Presbyterian Hospital Manual, edited by Niloo M. Edwards, MD, Jonathan M. Chen, MD, and Pamela A. Mazzeo, 2004 Coronary Disease in Women: Evidence-Based Diagnosis and Treatment, edited by Leslee J. Shaw, PhD and Rita F. Redberg, MD, FACC, 2004 Complementary and Alternative Cardiovascular Medicine, edited by Richard A. Stein, MD and Mehmet C. Oz, MD, 2004 Nuclear Cardiology, The Basics: How to Set Up and Maintain a Laboratory, by Frans J. Th. Wackers, MD, PhD, Wendy Bruni, BS, CNMT, and Barry L. Zaret, MD, 2004 Minimally Invasive Cardiac Surgery, Second Edition, edited by Daniel J. Goldstein, MD, and Mehmet C. Oz, MD 2004 Cardiovascular Health Care Economics, edited by William S. Weintraub, MD, 2003 Platelet Glycoprotein IIb/IIIa Inhibitors in Cardiovascular Disease, Second Edition, edited by A. Michael Lincoff, MD, 2003 Heart Failure: A Clinician s Guide to Ambulatory Diagnosis and Treatment, edited by Mariell L. Jessup, MD and Evan Loh, MD, 2003

3 CARDIOVASCULAR DISEASE IN THE ELDERLY Edited by GARY GERSTENBLITH, MD Johns Hopkins University School of Medicine Baltimore, MD

4 2005 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey humanapress.com For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: ; Fax: ; or visit our Website: All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All articles, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. Production Editor: Robin B. Weisberg Cover design by Patricia F. Cleary This publication is printed on acid-free paper. ANSI Z (American National Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $30.00 per copy is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [ /05 $30.00]. Printed in the United States of America e-isbn: Library of Congress Cataloging-in-Publication Data Cardiovascular disease in the elderly / edited by Gary Gerstenblith. p. ; cm. Includes bibliographical references and index. ISBN (alk. paper) 1. Geriatric cardiology. [DNLM: 1. Cardiovascular Diseases--physiopathology--Aged. 2. Aging--physiology. 3. Cardiovascular Diseases--therapy--Aged. WG 120 C ] I. Gerstenblith, Gary. RC669.C '612--dc

5 PREFACE The number of older individuals, and the proportion that they represent of the total population, are rapidly increasing. Even more striking is the high proportion the elderly represent of the patient population with cardiovascular disease (CVD). This is due in part to demographic trends, but also to more successful identification, prevention, and management strategies employed in the middle-aged population. As the number of older individuals and the multitude of new treatments for them continue to grow, health care providers are increasingly called on to make decisions as to whether or not to recommend these therapies. It is unclear, however, whether or not diagnostic and therapeutic interventions employed in the younger age groups can be extrapolated to the elderly because of differences in physiology, expected life span, complication rates, and increased co-morbidities. Cardiovascular Disease in the Elderly is intended for physicians and other health care providers who care for older patients with or at risk for CVD. It reviews physiological changes associated with the normal aging process that increase the likelihood for the development of disease and for adverse consequences once disease develops, and which alter the benefit risk equation for medical and other interventions designed to diagnose, assess, and treat CVD. This text discusses primary and secondary prevention strategies as well as the treatment of acute and chronic ischemic disease and complications. It focuses on presentations that are particularly common in the elderly as well, including cardiac failure with normal ejection fraction, isolated systolic hypertension, and atrial fibrillation, and has endeavored to take an evidenced-based approach to recommendations that rely heavily on prospective clinical trials. This text emphasizes new risk factors associated with age, including insulin resistance, and the value of lifestyle changes in the aging population. The chapters are written by leading experts in their fields who have studied extensively, and in many cases conducted, the studies on which current recommendations are based. Gary Gerstenblith, MD v

6 CONTENTS Preface...v Contributors... ix 1 Aging of the Heart and Arteries: Relevance to Cardiovascular Disease...1 Samer S. Najjar and Edward G. Lakatta 2 Frailty: Keystone in the Bridge Between Geriatrics and Cardiology...51 William Russell Hazzard 3 Cardiovascular Risk Factors in the Elderly: Evaluation and Intervention...79 Susan J. Zieman and Beth R. Malasky 4 Stable Coronary Artery Disease in the Elderly Beth R. Malasky and Joseph S. Alpert 5 Age and Mortality and Morbidity in ST-Segment Elevation Myocardial Infarction Steven P. Schulman and Gary Gerstenblith 6 Unstable Angina/Non-ST-Elevation Myocardial Infarction in the Elderly Stephen D. Wiviott and Christopher P. Cannon 7 Percutaneous Coronary Intervention in the Elderly Michael J. McWilliams and Eric J. Topol 8 Cardiac Surgery in the Elderly David D. Yuh and William A. Baumgartner 9 Heart Failure in the Elderly Michael W. Rich 10 Valvular Heart Disease in the Elderly Milind Y. Desai and Gary Gerstenblith 11 Arrhythmia Management in the Elderly Jonathan P. Piccini and Hugh Calkins vii

7 viii Contents 12 Peripheral Arterial Disease in the Elderly Emile R. Mohler III and William R. Hiatt 13 Cardiac Rehabilitation in Older Cardiac Patients Philip A. Ades 14 Clinical Pharmacology Janice B. Schwartz 15 Medical Treatment of the Cardiac Patient Approaching the End of Life Lofty L. Basta, W. Daniel Doty, and Michael D. D. Geldart Index...401

8 CONTRIBUTORS PHILIP A. ADES, MD, Division of Cardiology, University of Vermont College of Medicine, Burlington VT JOSEPH S. ALPERT, MD, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ LOFTY L. BASTA, MD, FRCP, FACC, Project GRACE, Clearwater, FL; Department of Medicine, University of South Florida College of Medicine, Tampa, FL WILLIAM A. BAUMGARTNER, MD, Division of Cardiac Surgery, Johns Hopkins HUGH CALKINS, MD, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD CHRISTOPHER P. CANNON, MD, Cardiovascular Division, Brigham and Women s Hospital and Harvard Medical School, Boston, MA MILIND Y. DESAI, MD, Division of Cardiology, Johns Hopkins W. DANIEL DOTY, MD, FACC, FAHA, Project GRACE, Clearwater, FL; Sacred Heart Regional Heart and Vascular Institute, Pensacola, FL MICHAEL D. D. GELDART, ESQ, Project GRACE, Clearwater, FL GARY GERSTENBLITH, MD, Division of Cardiology, Johns Hopkins WILLIAM RUSSELL HAZZARD, MD, Division of Gerontology and Geriatric Medicine, University of Washington School of Medicine, VA Puget Sound Health Care System, Seattle, WA WILLIAM R. HIATT, MD, Section of Vascular Medicine, University of Colorado Health Sciences Center and the Colorado Prevention Center, Divisions of Geriatrics and Cardiology, Denver, CO EDWARD G. LAKATTA, MD, Gerontology Research Center, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD BETH R. MALASKY, MD, The Native American Cardiology Program, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ MICHAEL J. MCWILLIAMS, MD, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH ix

9 x Contributors EMILE R. MOHLER III, MD, Cardiovascular Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA SAMER S. NAJJAR, MD, Gerontology Research Center, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD JONATHAN P. PICCINI, MD, Division of Cardiology, Johns Hopkins MICHAEL W. RICH, MD, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO STEVEN P. SCHULMAN, MD, Division of Cardiology, Johns Hopkins JANICE B. SCHWARTZ, MD, Department of Research, Jewish Home, San Francisco; Departments of Medicine, Cardiology, and Clinical Pharmacology, University of California, San Francisco School of Medicine, San Francisco, CA ERIC J. TOPOL, MD, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH STEPHEN D. WIVIOTT, MD, Cardiovascular Division, Brigham and Women s Hospital and Harvard Medical School, Boston, MA DAVID D. YUH, MD, Division of Cardiac Surgery, Johns Hopkins SUSAN J. ZIEMAN, MD, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD