Cardiovascular Disease

  • Nanette Kass Wenger
Chapter

Abstract

Aging of populations, common in the industrialized world, is rapidly becoming a characteristic of developing nations as well. Two thirds of the world’s 600 million people aged 60 years or older are projected to reside in developing nations by the year 2000. Not only is the elderly population increasing worldwide, but the aged population itself is becoming older as more people survive to older ages. Cardiovascular disease increases dramatically with aging and is the major cause of death and disability in elderly persons; 83% of all cardiovascular deaths in the United States occur in patients older than 65 years of age.1 Coronary heart disease is the most prevalent cardiac problem, followed by hypertensive cardiovascular disease. The problem facing all societies is how to pay for the care, rather than the cure, that is characteristic of chronic illness. Elderly patients constitute a highly heterogeneous group, with widely differing functional status, severities of illness, expectations of medical therapy, and psychosocial needs, none of which relates substantially either to each other or to chronologic age. Recent data suggest that the management and outcomes for most patients aged 65 to 75 years are comparable to that for their younger counterparts, but that cardiovascular diagnosis and therapy must be highly individualized beyond this age. The challenge is to identify the characteristics of people who remain active, alert, and energetic into old age, and to determine how lifestyle components, including nutrition, obesity, exercise, psychosocial features, work, retirement, and others, affect aging. This information can guide the preventive measures that may decrease disability in later life.

Keywords

Atrial Fibrillation Acute Myocardial Infarction Aortic Stenosis Mitral Regurgitation Infective Endocarditis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    National Center for Health Statistics. Advance report of final mortality statistics, 1988. In: Monthly Vital Statistics Report, vol. 39, no. 7 suppl. Hyattsville, MD: Public Health Service; 1990: 1–48.Google Scholar
  2. 2.
    Fleg JL, Lakatta EG. Role of muscle loss in the age-associated reduction in VO2 max. J Appl Physiol. 1988; 65: 1147–1151.PubMedGoogle Scholar
  3. 3.
    Lernfelt B, Wikstrand J, Svanborg A, et al. Aging and left ventricular function in elderly healthy people. Am J Cardiol. 1991; 68: 547–549.PubMedCrossRefGoogle Scholar
  4. 4.
    Mader SL, Josephson KR, Rubenstein LZ. Low prevalence of postural hypotension among community-dwelling elderly. JAMA. 1987; 258: 1511–1514.PubMedCrossRefGoogle Scholar
  5. 5.
    Rutan GH, Hermanson B, Bild DE, et al. Orthostatic hypotension in older adults. The Cardiovascular Health Study. Hypertension. 1992; 19 (part 1): 508–519.PubMedCrossRefGoogle Scholar
  6. 6.
    Bild DE, Fitzpatrick A, Fried LP, et al. Age-related trends in cardiovascular morbidity and physical functioning in the elderly: The Cardiovascular Health Study. J Am Geriatr Soc. 1993; 41: 1047–1056.PubMedGoogle Scholar
  7. 7.
    Newman AB, Siscovick DS, Manolio TA, et al. Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Circulation. 1993; 88: 837–845.PubMedCrossRefGoogle Scholar
  8. 8.
    Gerstenblith G. Noninvasive assessment of cardiac function in the elderly. In Weisfeldt M, ed. The Aging Heart: Its Function and Response to Stress. New York: Raven Press; 1984: 247–267.Google Scholar
  9. 9.
    Furberg CD, Manolio TA, Psaty BM, et al. Major electrocardiographic abnormalities in persons aged 65 years and older (the Cardiovascular Health Study). Am J Cardiol. 1992; 69: 1329–1335.PubMedCrossRefGoogle Scholar
  10. 10.
    Ingerslev J, Bjerregaard P. Prevalence and prognostic significance of cardiac arrhythmias detected by ambulatory electrocardiography in subjects 85 years of age. Eur Heart J. 1986; 7: 570–575.PubMedGoogle Scholar
  11. 11.
    Come PC, Riley MF, McKay RG, et al. Echocardiographic assessment of aortic valve area in elderly patients with aortic stenosis and of changes in valve area after per-cutaneous balloon valvuloplasty. J Am Coll Cardiol. 1987; 10: 115–124.PubMedCrossRefGoogle Scholar
  12. 12.
    Deckers JW, Simoons ML, Fioretti P. The value of exercise testing in elderly patients. Ger Cardiovasc Med. 1988; 1: 89–93.Google Scholar
  13. 13.
    Lam JYT, Chaitman BR, Glaenzer M. Safety and diagnostic accuracy in dipyridamole-thallium imaging in the elderly. J Am Coll Cardiol. 1988; 11: 585–589.PubMedCrossRefGoogle Scholar
  14. 14.
    Iskandrian AS, Heo J, Decoskey D, et al. Use of exercise thallium-201 imaging for risk stratification of elderly patients with coronary artery disease. Am J Cardiol. 1988; 61: 269–272.PubMedCrossRefGoogle Scholar
  15. 15.
    Smith WM. Epidemiology of congestive heart failure. Am J Cardiol. 1985; 55: 3A - 8A.PubMedCrossRefGoogle Scholar
  16. 16.
    Konstam MA, Dracup K, Baker D, et al. Heart Failure: Evaluation and Care of Patients with Left-Ventricular Systolic Dysfunction. Clinic Practice Guideline No. 11. AHCPR Publication No. 94–0612. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services; June 1994.Google Scholar
  17. 17.
    Wenger NK, Franciosa JA, Weber KT. 18th Bethesda Conference. Cardiovascular disease in the elderly. Heart failure. J Am Coll Cardiol. 1987;10(suppl A):73A76A.Google Scholar
  18. 18.
    Wong WF, Gold S, Fukuyama O, et al. Diastolic dysfunction in elderly patients with congestive heart failure. Am J Cardiol. 1989; 63: 1526–1528.PubMedCrossRefGoogle Scholar
  19. 19.
    Kessler KM. Heart failure with normal systolic function. Update of prevalence, differential diagnosis, prognosis and therapy (editorial). Arch Intern Med. 1988; 148: 2109–2111.PubMedCrossRefGoogle Scholar
  20. 20.
    Cody RJ, Torre S, Clark M, et al. Age-related hemodynamic, renal, and hormonal differences among patients with congestive heart failure. Arch Intern Med. 1989; 149: 1023–1028.PubMedCrossRefGoogle Scholar
  21. 21.
    The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987; 316: 1429–1435.Google Scholar
  22. 22.
    Furberg CD, Yusuf S, Thom TJ. Potential for altering the natural history of congestive heart failure. Am J Cardiol. 1985; 55: 45A - 47A.PubMedCrossRefGoogle Scholar
  23. 23.
    The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991; 325: 293–302.CrossRefGoogle Scholar
  24. 24.
    Cohn JN, Johnson G, Ziesche S, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. 1991; 325: 303–310.PubMedCrossRefGoogle Scholar
  25. 25.
    Chapman D, Wang T, Gheorghiade M. Therapeutic approaches to heart failure in elderly patients. Cardiol Elderly. 1994; 2: 89–97.Google Scholar
  26. 26.
    Packer M, Gheorghiade M, Young JB, et al. Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors. N Engl J Med. 1993; 329: 1–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Giannuzzi P, Tavazzi L, Temporelli PL, et al., for the EAMI Study Group. Long-term physical training and left ventricular remodeling after anterior myocardial infarction: results of the Exercise in Anterior Myocardial Infarction (EAMI) Trial. J Am Coll Cardiol. 1993; 22: 1821–1829.PubMedCrossRefGoogle Scholar
  28. 28.
    Marcus FI, Ruskin JN, Surawicz B. 18th Bethesda Conference. Cardiovascular disease in the elderly. Arrhythmias. J Am Coll Cardiol. 1987; 10 (suppl A): 66A - 72A.PubMedCrossRefGoogle Scholar
  29. 29.
    Bharati S, Lev M. Pathologic changes of the conduction system with aging. Cardiol Elderly. 1994; 2: 152–160.Google Scholar
  30. 30.
    Lipsitz LA, Wei JY, Rowe JW. Syncope in an elderly institutionalized population: prevalence, incidence, and associated risk. Q J Med. 1985; 55: 45–54.PubMedGoogle Scholar
  31. 31.
    Gordon M, Huang M, Gryfe CI. An evaluation of falls, syncope and dizziness in prolonged ambulatory cardiographic monitoring in a geriatric institutional setting. J Am Geriatr Soc. 1982; 30: 6–12.PubMedGoogle Scholar
  32. 32.
    Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. Arch Intern Med. 1987; 147: 1561–1564.PubMedCrossRefGoogle Scholar
  33. 33.
    The Stroke Prevention in Atrial Fibrillation Investigators. Stroke prevention in atrial fibrillation study: final results. Circulation. 1991; 84: 527–539.Google Scholar
  34. 34.
    Aronow WS, Mercando AD, Epstein S, et al. Effect of quinidine or procainamide versus no antiarrhythmic drug on sudden cardiac death, total cardiac death, and total death in elderly patients with heart disease and complex ventricular arrhythmias. Am J Cardiol. 1990; 66: 423–428.PubMedCrossRefGoogle Scholar
  35. 35.
    Tresch DD, Troup PJ, Thakur RK, et al. Comparison of efficacy of automatic implantable cardioverter defibrillator in patients older and younger than 65 years of age. Am J Med. 1991; 90: 717–724.PubMedGoogle Scholar
  36. 36.
    Shen W-K, Hayes DL. Pacing the octogenarians and nonagenarians: Should age be a consideration for pacing and outcome analysis of pacing in the very elderly? Cardiol Elderly. 1994; 2: 161–170.Google Scholar
  37. 37.
    Dreifus LS, Fisch C, Griffin JC, et al. Guidelines for implantation of cardiac pacemakers and antiarrhythmia devices. A report of the American College of Cardiology/ American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Pacemaker Implantation). J Am Coll Cardiol. 1991; 18: 1–13.PubMedCrossRefGoogle Scholar
  38. 38.
    Wenger NK, Furberg CD, Pitt E. Coronary Heart Disease in the Elderly: Working Conference on the Recognition and Management of Coronary Heart Disease in the Elderly, National Institutes of Health, Bethesda 1985. New York: Elsevier Science; 1986.Google Scholar
  39. 39.
    Graves EJ. Summary, 1989 National Hospital Discharge Survey: Advance Data from Vital and Health Statistics, no. 199. Hyattsville, MD; National Center for Health Statistics; 1991: 1–12.Google Scholar
  40. 40.
    Umachandran V, Ranjadayalan K, Ambepityia G, et al. Aging, autonomic function, and the perception of angina. Br Heart J. 1991; 66: 15–18.PubMedCrossRefGoogle Scholar
  41. 41.
    LaCroix AZ, Guralnik JM, Curb JD, et al. Chest pain and coronary heart disease mortality among older men and women in three communities. Circulation. 1990; 81: 437–446.PubMedCrossRefGoogle Scholar
  42. 42.
    Pepine CJ, Abrams J, Marks RG, et al., for the TIDES Investigators. Characteristics of a contemporary population with angina pectoris. Am J Cardiol. 1994; 74: 226–231.PubMedCrossRefGoogle Scholar
  43. 43.
    Mittelmark MB, Psaty BM, Rautaharju PM, et al. Prevalence of cardiovascular diseases among older adults. The Cardiovascular Health Study. Am J Epidemiol. 1993; 137: 311–317.PubMedGoogle Scholar
  44. 44.
    Nadelmann J, Frishman WH, Ooi WL, et al. Prevalence, incidence and prognosis of recognized and unrecognized myocardial infarction in persons aged 75 years or older: The Bronx Aging Study. Am J Cardiol. 1990; 66: 533–537.PubMedCrossRefGoogle Scholar
  45. 45.
    Solomon CG, Lee TH, Cook EF, et al. Comparison of clinical presentation of acute myocardial infarction in patients older than 65 years of age to younger patients: The Multicenter Chest Pain Study experience. Am J Cardiol. 1989; 63: 772–776.PubMedCrossRefGoogle Scholar
  46. 46.
    Hong RA, Licht JD, Wei JY, et al. Elevated CK-MB with normal total creatine kinase in suspected myocardial infarction: associated clinical findings and early prognosis. Am Heart J. 1986; 111: 1041–1047.PubMedCrossRefGoogle Scholar
  47. 47.
    Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico (GISSI). Long-term effects of intravenous thrombolysis in acute myocardial infarction: final report of the GISSI study. Lancet. 1987; 2: 871–874.Google Scholar
  48. 48.
    Wilcox RG, von der Lippe G, Olsson CG, et al., for the Anglo-Scandinavian Study of Early Thrombolysis. Effects of alteplase in acute myocardial infarction: 6-month results from the ASSET study. Lancet. 1990; 335: 1175 1178.Google Scholar
  49. 49.
    AIMS Trial Study Group. Long-term effects of intravenous anistreplase in acute myocardial infarction: final report of the AIMS study. Lancet. 1990; 335: 427–431.Google Scholar
  50. 50.
    Chaitman BR, Thompson B, Wittry MD, et al. The use of tissue-type plasminogen activator for acute myocardial infarction in the elderly: results from Thrombolysis in Myocardial Infarction Phase I, open label studies, and the Thrombolysis in Myocardial Infarction Phase II pilot study. J Am Coll Cardiol. 1989; 14: 1159–1165.PubMedCrossRefGoogle Scholar
  51. 51.
    The International Study Group. In-hospital mortality and clinicalcourse of 20,891 patients with suspected acute myocardial infarction randomised between alteplase and streptokinase with or without heparin. Lancet. 1990; 336: 71–75.CrossRefGoogle Scholar
  52. 52.
    Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI-2). A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Lancet. 1990; 336: 65–71.Google Scholar
  53. 53.
    Gore JM, Sloan M, Price TR, et al. Intracerebral hemorrhage, cerebral infarction, and subdural hematoma after acute myocardial infarction and thrombolytic therapy in the Thrombolysis in Myocardial Infarction Study: Thrombolysis in Myocardial Infarction, Phase II, pilot and clinical trial. Circulation. 1991; 83: 448–459.PubMedCrossRefGoogle Scholar
  54. 54.
    Weaver WD, Litwin PE, Martin JS, et al. Effect of age on use of thrombolytic therapy and mortality in acute myocardial infarction. J Am Coll Cardiol. 1991; 18: 657–662.PubMedCrossRefGoogle Scholar
  55. 55.
    Pfeffer MA, Moye LA, Braunwald E, et al. Selection bias in the use of thrombolytic therapy in acute myocardial infarction. JA MA. 1991; 266: 528–532.Google Scholar
  56. 56.
    Maggioni AP, Maseri A, Fresco C, et al., on behalf of the Investigators of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI-2). Age-related increase in mortality among patients with first myocardial infarctions treated with thrombolysis. N Engl J Med. 1993; 329: 1442–1448.PubMedCrossRefGoogle Scholar
  57. 57.
    Forman DE, Bernal JLG, Wei JY. Management of acute myocardial infarction in the very elderly. Am J Med. 1992; 93: 315–326.PubMedCrossRefGoogle Scholar
  58. 58.
    Pashos CL, Newhouse JP, McNeil BJ. Temporal changes in the care and outcomes of elderly patients with acute myocardial infarction, 1987 through 1990. JAMA. 1993; 270: 1832–1836.PubMedCrossRefGoogle Scholar
  59. 59.
    Smith SC Jr, Gilpin E, Ahnve S, et al. Outlook after acute myocardial infarction in the very elderly compared with that in patients aged 65 to 75 years. J Am Coll Cardiol. 1990; 16: 784–792.PubMedCrossRefGoogle Scholar
  60. 60.
    MacMahon S, Collins R, Peto R, et al. Effects of prophylactic lidocaine in suspected acute myocardial infarction: an overview of results from the randomized, controlled trials. JAMA. 1988; 260: 1910–1916.PubMedCrossRefGoogle Scholar
  61. 61.
    Gundersen T, Abrahamsen AM, Kjekshus J, et al., for the Norwegian Multicentre Study Group. Timolol-related reduction in mortality and reinfarction in patients ages 65–75 years surviving acute myocardial infarction. Circulation. 1982; 66: 1179–1184.PubMedCrossRefGoogle Scholar
  62. 62.
    Gurwitz JH, Goldberg RJ, Chen Z, et al. ß-Blocker therapy in acute myocardial infarction: evidence for underutilization in the elderly. Am J Med. 1992; 93: 605–610.PubMedCrossRefGoogle Scholar
  63. 63.
    ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet. 1988; 2: 349–360.Google Scholar
  64. 64.
    Pfeffer MA, Braunwald E, Moyé LA, et al., on behalf of the SAVE Investigators. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the Survival and Ventricular Enlargement Trial. N Engl J Med. 1992; 327: 669–677.PubMedCrossRefGoogle Scholar
  65. 65.
    Second Report of the Sixty-Plus Reinfarction Group. Risk of long-term anticoagulant therapy in elderly patients after myocardial infarction. Lancet. 1982; 1: 64–68.Google Scholar
  66. 66.
    Smith P, Arnesen H, Holme I. The effect of warfarin on mortality and reinfarction after myocardial infarction. N Engl J Med. 1990; 323: 147–152.PubMedCrossRefGoogle Scholar
  67. 67.
    Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo: the Cardiac Arrhythmia Suppression Trial. N Engl J Med. 1991; 324: 781–788.PubMedCrossRefGoogle Scholar
  68. 68.
    Fioretti P, Deckers JW, Brower RW, et al. Predischarge stress test after myocardial infarction in old age: results and prognostic value. Eur Heart J. 1984; 5 (suppl E): 101–104.PubMedCrossRefGoogle Scholar
  69. 69.
    Wenger NK. Populations with special needs for exercise rehabilitation. Elderly coronary patients. In: Wenger NK, Hellerstein HK, eds. Rehabilitation of the Coronary Patient. 3d ed. New York: Churchill-Livingstone; 1992: 415–420.Google Scholar
  70. 70.
    Lavie CJ, Milani RV, Littman AB. Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly. J Am Coll Cardiol. 1993; 22: 678–683.PubMedCrossRefGoogle Scholar
  71. 71.
    Ades PA, Waldmann ML, Poehlman ET, et al. Exercise conditioning in older coronary patients: submaximal lactate response and endurance capacity. Circulation. 1993; 88: 572–577.PubMedCrossRefGoogle Scholar
  72. 72.
    O’Keefe JH Jr, Sutton MB, McCallister BD, et al. Coronary angioplasty versus bypass surgery in patients 70 years old matched for ventricular function. J Am Coll Cardiol. 1994; 24: 425–430.PubMedCrossRefGoogle Scholar
  73. 73.
    Naunheim KS, Dean PA, Firoe AC, et al. Cardiac surgery in the octogenarian. Eur J Cardiothorac Surg. 1990; 4: 130–135.PubMedCrossRefGoogle Scholar
  74. 74.
    Weintraub WS, Clements SD, Ware J, et al. Coronary artery surgery in octogenarians. Am J Cardiol. 1991; 68: 1530–1534.PubMedCrossRefGoogle Scholar
  75. 75.
    Glower DD, Christopher TD, Milano CA, et al. Performance status and outcome after coronary artery bypass grafting in persons aged 80 to 93 years. Am J Cardiol. 1992; 70: 567–571.PubMedCrossRefGoogle Scholar
  76. 76.
    Ko W, Gold JP, Lazzaro R, et al. Survival analysis of octogenarian patients with coronary artery disease managed by elective coronary artery bypass surgery versus conventional medical treatment. Circulation. 1992; 86(suppl II):II-191-II-197.Google Scholar
  77. 77.
    Horvath KA, DiSesa VJ, Peigh PS, et al. Favorable results of coronary artery bypass grafting in patients older than 75 years. J Thorac Cardiovasc Surg. 1990; 99: 92–96.PubMedGoogle Scholar
  78. 78.
    Gersh BJ, Kronmal RA, Schaff HV, et al., and participants in the CASS Study. Comparison of coronary artery surgery and medical therapy in patients 65 years of age or older: a nonrandomized study from the Coronary Artery Surgery Study (CASS) Registry. N Engl J Med. 1985; 313: 217–224.PubMedCrossRefGoogle Scholar
  79. 79.
    Kelsey SF, Miller DP, Holubkov R, et al. Results of percutaneous transluminal coronary angioplasty in patients 65 years of age (from the 1985 to 1986 National Heart, Lung, and Blood Institute’s Coronary Angioplasty Registry). Am J Cardiol. 1990; 66: 1033–1038.PubMedCrossRefGoogle Scholar
  80. 80.
    Bedotto JB, Rutherford BD, McConahay DR, et al. Results of multivessel percutaneous transluminal coronary angioplasty in persons aged 65 years and older. Am J Cardiol. 1991; 67: 1051–1055.PubMedCrossRefGoogle Scholar
  81. 81.
    Jackman JD, Navetta FI, Smith JE, et al. Percutaneous transluminal coronary angioplasty in octogenarians as an effective therapy for angina pectoris. Am J Cardiol. 1991; 68: 116–119.PubMedCrossRefGoogle Scholar
  82. 82.
    Weyrens FJ, Goldenberg I, Mooney JF, et al. Percutaneous transluminal coronary angioplasty in patients aged 90 years. Am J Cardiol. 1994; 74: 397–398.PubMedCrossRefGoogle Scholar
  83. 83.
    National High Blood Pressure Education Program Working Group: National High Blood Pressure Education Program Working Group Report on Hypertension in the Elderly. Hypertension. 1994; 23: 275–285.CrossRefGoogle Scholar
  84. 84.
    Staessen J, Amery A, Fagard R. Editorial review. Isolated systolic hypertension in the elderly. J Hypertens. 1990; 8: 393–405.PubMedCrossRefGoogle Scholar
  85. 85.
    Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension, III: Influence of age, diastolic pressure, and prior cardiovascular disease: further analysis of side effects. Circulation. 1972; 45: 991–1004.Google Scholar
  86. 86.
    Amery A, Birkenhager W, Brixko P, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial. Lancet. 1985; 1: 1349–1354.PubMedCrossRefGoogle Scholar
  87. 87.
    SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991; 265: 3255–3264.CrossRefGoogle Scholar
  88. 88.
    The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med. 1993; 153: 154–183.Google Scholar
  89. 89.
    Johnson AG, Nguyen TV, Day RO. Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis. Ann Intern Med. 1994; 121: 289–300.PubMedGoogle Scholar
  90. 90.
    Staessen J, Fagard R, Lijnen P, et al. Review of the major hypertension trials in the elderly. Cardiovasc Drugs Ther. 1990; 4 (suppl 6): 1237–1247.CrossRefGoogle Scholar
  91. 91.
    Culliford AT, Galloway AC, Colvin SB, et al. Aortic valve replacement for aortic stenosis in persons aged 80 years and over. Am J Cardiol. 1991; 67: 1256–1260.PubMedCrossRefGoogle Scholar
  92. 92.
    Nylander E, Ekman I, Marklund T, et al. Severe aortic stenosis in elderly patients. Br Heart J. 1986; 55: 480–487.PubMedCrossRefGoogle Scholar
  93. 93.
    Horstkotte D, Loogen F. The natural history of aortic valve stenosis. Eur Heart J. 1988; 9 (suppl E): 57–64.PubMedCrossRefGoogle Scholar
  94. 94.
    Lombard JT, Selzer A. Valvular aortic stenosis: a clinical and hemodynamic profile of patients. Ann Intern Med. 1987; 606: 292–298.Google Scholar
  95. 95.
    Lund O, Neilsen TT, Magrussen K, et al. Valve replacement for calcified aortic stenosis in septuagenarians infers normal life-length. Scand J Cardiovasc Surg. 1991; 25: 37–44.CrossRefGoogle Scholar
  96. 96.
    Aranki SF, Rizzo RJ, Couper GS, et al. Aortic valve replacement in the elderly. Effect of gender and coronary artery disease on operative mortality. Circulation. 1993; 88 (part 2): 17–23.Google Scholar
  97. 97.
    Craver JM, Weintraub WS, Jones EL, et al. Predictors of mortality, complications, and length of stay in aortic valve replacement for aortic stenosis. Circulation. 1988;78(suppl I):1–85-I-90.Google Scholar
  98. 98.
    McKay CR, Waller BF. Current status of balloon valvuloplasty. Cardiol Elderly. 1993; 1: 77–85.Google Scholar
  99. 99.
    O’Neill WW, for the Mansfield Scientific Aortic Valvuloplasty Registry Investigators. Predictors of longterm survival after percutaneous aortic valvuloplasty: report of the Mansfield Scientific Balloon Aortic Valvuloplasty Registry. J Am Coll Cardiol. 1991; 17: 193–198.PubMedCrossRefGoogle Scholar
  100. 100.
    Kolibash AJ, Bush CA, Fontana MB, et al. Mitral valve prolapse syndrome: analysis of 62 patients aged 60 years and older. Am J Cardiol. 1983; 52: 534–539.PubMedCrossRefGoogle Scholar
  101. 101.
    Hochberg MS, Derkac WM, Conkle DM, et al. Mitral valve replacement in elderly patients: encouraging postoperative clinical and hemodynamic results. J Thorac Cardiovasc Surg. 1979; 77: 422–426.PubMedGoogle Scholar
  102. 102.
    Tsai TP, Matloff JM, Chaux A, et al. Combined valve and coronary artery bypass procedures in septuagenarians and octogenarians: results in 120 patients. Ann Thorac Surg. 1986; 42: 681–684.PubMedCrossRefGoogle Scholar
  103. 103.
    Freeman WK, Schaff HV, O’Brien PC, et al. Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol. 1991; 18: 29–35.PubMedCrossRefGoogle Scholar
  104. 104.
    Cheitlin MD. Congenital heart disease in the adult. Mod Conc Cardiovasc Dis. 1986; 55: 20–24.Google Scholar
  105. 105.
    Terpenning MS, Buggy BP, Kauffman CA. Infective endocarditis: clinical features in young and elderly patients. Am J Med. 1987; 83: 626–634.PubMedCrossRefGoogle Scholar
  106. 106.
    Dajani AS, Bisno AL, Chung KJ, et al. Prevention of bacterial endocarditis: Recommendations by the American Heart Association. JAMA. 1990; 264: 2919–2922.PubMedCrossRefGoogle Scholar
  107. 107.
    Kearney RA, Eisen HJ, Wolf JE. Nonvalvular infections of the cardiovascular system. Ann Intern Med. 194; 121: 219–230.Google Scholar
  108. 108.
    Krasnow N, Stein RA. Hypertrophic cardiomyopathy in the aged. Am Heart J. 1978; 96: 326–336.PubMedCrossRefGoogle Scholar
  109. 109.
    Lewis JF, Maron BJ. Clinical and morphologic expression of hypertrophic cardiomyopathy in patients _65 years of age. Am J Cardiol. 1994; 73: 1105–1111.PubMedCrossRefGoogle Scholar
  110. 110.
    Shah PM, Abelmann WH, Gersh BJ. 18th Bethesda Conference. Cardiovascular Disease in the Elderly. Cardiomyopathies in the elderly. J Am Coll Cardiol. 1987; 10 (suppl A): 77A - 79A.PubMedCrossRefGoogle Scholar
  111. 111.
    Stein PD, Gottschalk A, Saltzman HA, et al. Diagnosis of acute pulmonary embolism in the elderly. J Am Coll Cardiol. 1991; 18: 1452–1457.PubMedCrossRefGoogle Scholar
  112. 112.
    Burrows B, Alpert JS, Ross JC. 18th Bethesda Conference. Cardiovascular Disease in the Elderly. Pulmonary heart disease. J Am Coll Cardiol. 1987;10(suppl A):63A65A.Google Scholar
  113. 113.
    Lowenthal DT, Affrime MB. Cardiovascular drugs for the geriatric patient. Geriatrics. 1981; 36: 65–74.PubMedGoogle Scholar
  114. 114.
    Lavarenne J, Dumas R, Cayrol C. Effets indésirables des médicaments chez les personnes âgées. Bilan des observation recueilliés pendant un an par l’Association Française des Centres de Pharmacovigilance. Therapie. 1993; 38: 485–493.Google Scholar
  115. 115.
    Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program: II. Mortality by race-sex and age. JAMA. 1979; 242: 2572–2577.CrossRefGoogle Scholar
  116. 116.
    Black DM, Brand RJ, Greenlick M, et al. Compliance to treatment for hypertension in elderly patients: The SHEP Pilot Study. J Gerontol. 1987; 42: 552–557.PubMedCrossRefGoogle Scholar
  117. 117.
    Schwartz JB, Abernethy DR. Cardiac drugs: adjusting their use in aging patients. Geriatrics. 1987; 42: 31–40.PubMedGoogle Scholar
  118. 118.
    Vestal RE, Wood AJ, Shand DG. Reduced betaadrenoreceptor sensitivity in the elderly. Clin Pharmacol Ther. 1979; 26: 181–186.PubMedGoogle Scholar
  119. 119.
    Gerson MC, Hurst JM, Hertzberg VS, et al. Cardiac prognosis in noncardiac geriatric surgery. Ann Intern Med. 1985; 103: 832–837.PubMedGoogle Scholar
  120. 120.
    Mangano DT. Perioperative cardiac morbidity. Anesthesiology. 1990; 72: 153–184.PubMedCrossRefGoogle Scholar
  121. 121.
    Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977; 197: 845–850.CrossRefGoogle Scholar
  122. 122.
    Freeman WK, Gibbons RJ, Shub C. Preoperative assessment of cardiac patients undergoing noncardiac surgical procedures. Mayo Clin Proc. 1989; 64: 1105–1117.PubMedCrossRefGoogle Scholar
  123. 123.
    Gersh BJ, Rihal CS, Rooke TW, et al. Evaluation and management of patients with both peripheral vascular and coronary artery disease. J Am Coll Cardiol. 1991; 18: 203214.Google Scholar
  124. 124.
    Towne JB, Weiss DG, Hobson RW II. First phase report of Cooperative Veterans Administration Asymptomatic Carotid Stenosis Study: operative morbidity and mortality. J Vasc Surg. 1990; 11: 252–259.PubMedGoogle Scholar
  125. 125.
    Kannel WB, Doyle JT, Shephard RJ, et al. 18th Bethesda Conference. Cardiovascular Disease in the Elderly. Prevention of cardiovascular disease in the elderly. J Am Coll Cardiol. 1987; 10 (suppl A): 25A - 28A.PubMedCrossRefGoogle Scholar
  126. 126.
    Snowdon DA, Phillips RL, Fraser GE. Meat consumption and fatal ischemic heart disease. Prey Med. 1984; 13: 490500.Google Scholar
  127. 127.
    The Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Summary of the Second Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA. 1993; 269: 30153025.Google Scholar
  128. 128.
    Denke MA, Grundy SM. Hypercholesterolemia in elderly persons: resolving the treatment dilemma. Ann Intern Med. 1990; 112: 780–792.PubMedGoogle Scholar
  129. 129.
    Carlson LA, Rosenhamer G. Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. Acta Med Scand. 1988; 223: 405–418.PubMedCrossRefGoogle Scholar
  130. 130.
    Jajich CL, Ostfeld AM, Freeman DH Jr. Smoking and coronary heart disease mortality in the elderly. JAMA. 1984; 252: 2831–2834.PubMedCrossRefGoogle Scholar
  131. 131.
    Hermanson B, Omenn GS, Kronmal RA, et al. Beneficial six-year outcome of smoking cessation in older men and women with coronary artery disease. Results from the CASS Registry. N Engl J Med. 1988; 319: 1365–1369.PubMedCrossRefGoogle Scholar
  132. 132.
    Reaven PD, Barrett-Connor E, Edelstein S. Relation between leisure-time physical activity and blood pressure in older women. Circulation. 1991; 83: 559–565.PubMedCrossRefGoogle Scholar
  133. 133.
    Pollock ML, Carroll JF, Graves JE, et al. Injuries and adherence to walk/jog and resistance training programs in the elderly. Med Sci Sports Exerc. 1991; 23: 1194–1200.PubMedGoogle Scholar
  134. 134.
    Manolio TA, Furberg CD, Shemanski L, et al., for the CHS Collaborative Research Group. Association of postmenopausal estrogen use with cardiovascular disease and its risk factors in older women. Circulation. 1993; 88 (part 1): 2163–2171.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Nanette Kass Wenger

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