Epidemiology, Pathophysiology, and Management of Coronary Artery Disease in the Elderly

Kahtan Fadah; Aimee Hechanova; Debabrata Mukherjee

doi:10.1055/s-0042-1751234

International Journal of Angiology, Inhaltsverzeichnis

Int J Angiol 2022; 31(04): 244-250
DOI: 10.1055/s-0042-1751234

Invited Article

Epidemiology, Pathophysiology, and Management of Coronary Artery Disease in the Elderly

Kahtan Fadah

¹Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas

,

Aimee Hechanova

¹Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas

,

Debabrata Mukherjee

²Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas

› Institutsangaben

Abstract

Elderly patients over the age of ≥ 75 years are especially susceptible to coronary artery disease (CAD) as age is an important nonmodifiable risk factors for atherosclerosis and a predictor of poorer outcomes. In fact, CAD is a major cause of mortality and morbidity in this population. Due to concerns of functional frailty, comorbidities, and patient preference of conservative to no treatment have played a role in reducing the interest in pursuing prospective studies in this high-risk group. In this review, we provide an overview of the epidemiology, pathophysiology, and management of CAD in older adults.

Keywords

elderly - aging - coronary artery disease - atherosclerosis - frailty - revascularization

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References
1 Mozaffarian D, Benjamin EJ, Go AS. et al; Writing Group Members, American Heart Association Statistics Committee, Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2016 update: a report from the American Heart Association. Circulation 2016; 133 (04) e38-e360
2 Phrommintikul A, Krittayaphong R, Wongcharoen W. et al; CORE investigators. Management and risk factor control of coronary artery disease in elderly versus nonelderly: a multicenter registry. J Geriatr Cardiol 2016; 13 (12) 954-959
3 Rodgers JL, Jones J, Bolleddu SI. et al. Cardiovascular risks associated with gender and aging. J Cardiovasc Dev Dis 2019; 6 (02) E19
4 Administration on Aging (AoA), U.S. Department of Health and Human Service. 2020 PROFILE OF OLDER AMERICANS, May 2021. Available at https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2020ProfileOlderAmericans.Final_.pdf
5 Forman DE, Rich MW, Alexander KP. et al. Cardiac care for older adults. Time for a new paradigm. J Am Coll Cardiol 2011; 57 (18) 1801-1810
6 Paneni F, Diaz Cañestro C, Libby P, Lüscher TF, Camici GG. The aging cardiovascular system: understanding it at the cellular and clinical levels. J Am Coll Cardiol 2017; 69 (15) 1952-1967
7 Wang JC, Bennett M. Aging and atherosclerosis: mechanisms, functional consequences, and potential therapeutics for cellular senescence. Circ Res 2012; 111 (02) 245-259
8 Head T, Daunert S, Goldschmidt-Clermont PJ. The aging risk and atherosclerosis: a fresh look at arterial homeostasis. Front Genet 2017; 8 (DEC): 216
9 Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I: aging arteries: a “set up” for vascular disease. Circulation 2003; 107 (01) 139-146
10 Yang YM, Huang A, Kaley G, Sun D. eNOS uncoupling and endothelial dysfunction in aged vessels. Am J Physiol Heart Circ Physiol 2009; 297 (05) H1829-H1836
11 Delp MD, Behnke BJ, Spier SA, Wu G, Muller-Delp JM. Ageing diminishes endothelium-dependent vasodilatation and tetrahydrobiopterin content in rat skeletal muscle arterioles. J Physiol 2008; 586 (04) 1161-1168
12 Winnik S, Auwerx J, Sinclair DA, Matter CM. Protective effects of sirtuins in cardiovascular diseases: from bench to bedside. Eur Heart J 2015; 36 (48) 3404-3412
13 Dikalov SI, Nazarewicz RR. Angiotensin II–induced production of mitochondrial reactive oxygen species: potential mechanisms and relevance for cardiovascular disease. Antioxid Redox Signal 2013; 19 (10) 1085-1094
14 Fritze O, Romero B, Schleicher M. et al. Age-related changes in the elastic tissue of the human aorta. J Vasc Res 2012; 49 (01) 77-86
15 Amento EP, Ehsani N, Palmer H, Libby P. Cytokines and growth factors positively and negatively regulate interstitial collagen gene expression in human vascular smooth muscle cells. Arterioscler Thromb 1991; 11 (05) 1223-1230
16 Hui G, Koch B, Calara F, Wong ND. Angina in coronary artery disease patients with and without diabetes: US National Health and Nutrition Examination Survey 2001-2010. Clin Cardiol 2016; 39 (01) 30-36
17 Buford TW. Hypertension and aging. Ageing Res Rev 2016; 26: 96-111
18 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 (18) 1887-1898
19 JNC8 Guidelines for the Management of Hypertension in Adults - Practice Guidelines - American Family Physician. Accessed May 3, 2022 at: https://www.aafp.org/afp/2014/1001/p503.html
20 Whelton PK, Carey RM, Aronow WS. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults a report of the American College of Cardiology/American Heart Association Task Force on Clinical practice guidelines. Hypertension 2018; 71 (06) e13-e115
21 New Guidance on Blood Pressure Management in Low-Risk Adults with Stage 1 Hypertension - American College of Cardiology. Accessed May 3, 2022 at: https://www.acc.org/latest-in-cardiology/articles/2021/06/21/13/05/new-guidance-on-bp-management-in-low-risk-adults-with-stage-1-htn
22 Prevalence of Both Diagnosed and Undiagnosed Diabetes | Diabetes | CDC. Accessed April 23, 2022 at: https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-undiagnosed-diabetes.html
23 Kosiborod M, Rathore SS, Inzucchi SE. et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 2005; 111 (23) 3078-3086
24 Boyd C, Smith CD, Masoudi FA. et al. Decision making for older adults with multiple chronic conditions: executive summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity. J Am Geriatr Soc 2019; 67 (04) 665-673
25 Association AD. American Diabetes Association. 1. Improving care and promoting health in populations: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41 (Suppl. 01) S7-S12
26 Patel A, MacMahon S, Chalmers J. et al; ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358 (24) 2560-2572
27 Gerstein HC, Miller ME, Byington RP. et al; Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358 (24) 2545-2559
28 Duckworth W, Abraira C, Moritz T. et al; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360 (02) 129-139
29 Diabetes Management in Older Adults with Cardiovascular Disease - American College of Cardiology. Accessed April 23, 2022 at: https://www.acc.org/latest-in-cardiology/articles/2018/02/28/12/19/diabetes-management-in-older-adults-with-cvd
30 Li N, Lv D, Zhu X. et al. Effects of SGLT2 inhibitors on renal outcomes in patients with chronic kidney disease: a meta-analysis. Front Med (Lausanne) 2021; 8: 728089
31 Fadah K, Alashi A, Deoker A. The enhanced cardiac outcome of conjugated SGLT2 inhibitors and GLP-1RA therapy in diabetic patients. Curr Cardiol Rep 2022; 24 (01) 17-22
32 Correa R, Wayar F, Reaven P, Corpas E. Dyslipidemia in the elderly. In: Corpas E. ed. Endocrinology of Aging. Amsterdam, The Netherlands: Elsevier; 2021: 607-650
33 Shao H, Chen LQ, Xu J. Treatment of dyslipidemia in the elderly. J Geriatr Cardiol 2011; 8 (01) 55-64
34 Grundy SM, Stone NJ, Bailey AL. et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 139 (25) e1082-e1143
35 Sternberg CN, Fizazi K, Saad F. et al; PROSPER Investigators. Enzalutamide and survival in nonmetastatic, castration-resistant prostate cancer. N Engl J Med 2020; 382 (23) 2197-2206
36 Wilson MM, Blaum C, Semba RD, Xue QL, Ricks MO, Fried LP. Aronow's “Should the NCEP III guidelines be changed in elderly and younger persons at high risk for cardiovascular events?” Cholesterol and the aged: ...and the beat goes on. J Gerontol A Biol Sci Med Sci 2005; 60 (05) 600-602 , author reply 602
37 Ridker PM. The JUPITER trial: results, controversies, and implications for prevention. Circ Cardiovasc Qual Outcomes 2009; 2 (03) 279-285
38 Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary artery disease in patients ≥80 years of age. J Am Coll Cardiol 2018; 71 (18) 2015-2040
39 A Clinical Trial of STAtin Therapy for Reducing Events in the Elderly (STAREE) - Full Text View - ClinicalTrials.gov. Accessed May 3, 2022 at: https://clinicaltrials.gov/ct2/show/NCT02099123
40 Pragmatic Evaluation of Events And Benefits of Lipid-lowering in Older Adults - Full Text View - ClinicalTrials.gov. Accessed May 3, 2022 at: https://clinicaltrials.gov/ct2/show/NCT04262206
41 Fried LF, Shlipak MG, Crump C. et al. Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals. J Am Coll Cardiol 2003; 41 (08) 1364-1372
42 Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options. Circulation 2021; 143 (11) 1157-1172
43 Sarnak MJ, Amann K, Bangalore S. et al; Conference Participants. Chronic kidney disease and coronary artery disease: JACC state-of-the-art review. J Am Coll Cardiol 2019; 74 (14) 1823-1838
44 Krane V, Schmidt KR, Gutjahr-Lengsfeld LJ. et al; 4D Study Investigators (the German Diabetes and Dialysis Study Investigators). Long-term effects following 4 years of randomized treatment with atorvastatin in patients with type 2 diabetes mellitus on hemodialysis. Kidney Int 2016; 89 (06) 1380-1387
45 Fellström BC, Jardine AG, Schmieder RE. et al; AURORA Study Group. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 2009; 360 (14) 1395-1407
46 Górriz JL, Soler MJ, Navarro-González JF. et al. GLP-1 receptor agonists and diabetic kidney disease: a call of attention to nephrologists. J Clin Med 2020; 9 (04) E947
47 A Research Study to See How Semaglutide Works Compared to Placebo in People With Type 2 Diabetes and Chronic Kidney Disease - Full Text View - ClinicalTrials.gov. Accessed May 3, 2022 at: https://clinicaltrials.gov/ct2/show/NCT03819153
48 Charytan DM, Wallentin L, Lagerqvist B. et al. Early angiography in patients with chronic kidney disease: a collaborative systematic review. Clin J Am Soc Nephrol 2009; 4 (06) 1032-1043
49 Mons U, Müezzinler A, Gellert C. et al; CHANCES Consortium. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ 2015; 350: h1551
50 Gallucci G, Tartarone A, Lerose R, Lalinga AV, Capobianco AM. Cardiovascular risk of smoking and benefits of smoking cessation. J Thorac Dis 2020; 12 (07) 3866-3876
51 Rowe R, Iqbal J, Murali-Krishnan R. et al. Role of frailty assessment in patients undergoing cardiac interventions. Open Heart 2014; 1 (01) e000033
52 Schopfer DW, Forman DE. Cardiac rehabilitation in older adults. Can J Cardiol 2016; 32 (09) 1088-1096
53 Andreotti F, Rocca B, Husted S. et al; ESC Thrombosis Working Group. Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J 2015; 36 (46) 3238-3249
54 Baigent C, Blackwell L, Collins R. et al; Antithrombotic Trialists' (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009; 373 (9678): 1849-1860
55 Virani SS, Smith Jr SC, Stone NJ, Grundy SM. Secondary prevention for atherosclerotic cardiovascular disease: comparing recent US and European guidelines on dyslipidemia. Circulation 2020; 141 (14) 1121-1123
56 Jacobsen AP, Raber I, McCarthy CP. et al. Lifelong aspirin for all in the secondary prevention of chronic coronary syndrome: still sacrosanct or is reappraisal warranted?. Circulation 2020; 142 (16) 1579-1590
57 Ideal Aspirin Dose for Secondary Prevention in Patients With ASCVD - American College of Cardiology. Accessed May 5, 2022 at: https://www.acc.org/latest-in-cardiology/articles/2021/08/19/13/25/ideal-aspirin-dose-for-secondary-prevention-in-patients-with-ascvd
58 Byrne RA, Colleran R. Aspirin for secondary prevention of cardiovascular disease. Lancet 2020; 395 (10235): 1462-1463
59 Mehta SR, Tanguay JF, Eikelboom JW. et al; CURRENT-OASIS 7 trial investigators. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet 2010; 376 (9748): 1233-1243
60 Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events−Seventh Organization to Assess Strategies in Ischemic Syndromes - American College of Cardiology. Accessed April 30, 2022 at: https://www.acc.org/latest-in-cardiology/clinical-trials/2010/09/16/16/01/current-oasis-7
61 Capodanno D, Angiolillo DJ. Antithrombotic therapy in the elderly. J Am Coll Cardiol 2010; 56 (21) 1683-1692
62 Lee SY, Hong MK, Palmerini T. et al. Short-term versus long-term dual antiplatelet therapy after drug-eluting stent implantation in elderly patients: a meta-analysis of individual participant data from 6 randomized trials. JACC Cardiovasc Interv 2018; 11 (05) 435-443
63 Optimal Antiplatelet Therapy for Prevention of Gastrointestinal Injury - American College of Cardiology. Accessed April 30, 2022 at: https://www.acc.org/latest-in-cardiology/clinical-trials/2021/11/02/22/31/opt-peace
64 Bittl JA, Laine L. Gastrointestinal injury caused by aspirin or clopidogrel monotherapy versus dual antiplatelet therapy. J Am Coll Cardiol 2022; 79 (02) 129-131
65 Li Y, Wang X, Bao D. et al. Optimal antiplatelet therapy for prevention of gastrointestinal injury evaluated by ANKON magnetically controlled capsule endoscopy: rationale and design of the OPT-PEACE trial. Am Heart J 2020; 228: 8-16
66 Blazing MA, de Lemos JA, White HD. et al; ‘A to Z’ Investigators. Safety and efficacy of enoxaparin vs unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes who receive tirofiban and aspirin: a randomized controlled trial. JAMA 2004; 292 (01) 55-64
67 Lopes RD, Alexander KP, Marcucci G. et al. Outcomes in elderly patients with acute coronary syndromes randomized to enoxaparin vs. unfractionated heparin: results from the SYNERGY trial. Eur Heart J 2008; 29 (15) 1827-1833
68 Wester A, Attar R, Mohammad MA. et al. Bivalirudin versus heparin monotherapy in elderly patients with myocardial infarction: a prespecified subgroup analysis of the VALIDATE-SWEDEHEART trial. Circ Cardiovasc Interv 2020; 13 (04) e008671
69 Yusuf S, Mehta SR, Chrolavicius S. et al; Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 2006; 354 (14) 1464-1476
70 Hess CN, Peterson ED, Peng SA. et al. Use and outcomes of triple therapy among older patients with acute myocardial infarction and atrial fibrillation. J Am Coll Cardiol 2015; 66 (06) 616-627
71 Dewilde WJM, Oirbans T, Verheugt FWA. et al; WOEST study investigators. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet 2013; 381 (9872): 1107-1115
72 Gibson CM, Mehran R, Bode C. et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 2016; 375 (25) 2423-2434
73 Cannon CP, Bhatt DL, Oldgren J. et al; RE-DUAL PCI Steering Committee and Investigators. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med 2017; 377 (16) 1513-1524
74 Guerrero C, Ariza-Solé A, Formiga F, Martínez-Sellés M, Vidán MT, Aboal J. Applicability of the PRECISE-DAPT score in elderly patients with myocardial infarction. J Geriatr Cardiol 2018; 15 (12) 713-717
75 Qian Y, Xu B, Qian X. et al. Incidence and risk factors for antiplatelet therapy-related bleeding complications among elderly patients after coronary stenting: a multicenter retrospective observation. Front Pharmacol 2021; 12: 661619
76 Alexander KP, Newby LK, Cannon CP. et al; American Heart Association Council on Clinical Cardiology, Society of Geriatric Cardiology. Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 2007; 115 (19) 2549-2569
77 Gharacholou SM, Alexander KP, Chen AY. et al. Implications and reasons for the lack of use of reperfusion therapy in patients with ST-segment elevation myocardial infarction: findings from the CRUSADE initiative. Am Heart J 2010; 159 (05) 757-763
78 Hannan EL, Wu C, Walford G. et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med 2008; 358 (04) 331-341
79 Jepma P, Jorstad HT, Snaterse M. et al. Lifestyle modification in older versus younger patients with coronary artery disease. Heart 2020; 106 (14) 1066-1072