Secondary prevention strategies should consider comorbidities, psychological issues, risks, benefits
TUESDAY, Oct. 29 (HealthDay News) -- For older adults, secondary prevention of atherosclerotic cardiovascular disease (ASCVD) should be individualized, according to a scientific statement published online Oct. 28 in Circulation.
Noting that the prevalence of ASCVD is increasing among older adults, and that few seniors are included in trials addressing secondary prevention of ASCVD, Jerome L. Fleg, M.D., from the National Institutes of Health in Bethesda, Md., and colleagues discuss the benefits and risks of secondary prevention interventions in older adults.
The researchers note that atherosclerotic risk factors are highly prevalent among older adults with ASCVD, including obesity, hypertension, hyperlipidemia, diabetes mellitus, and tobacco. Management of these risk factors, including pharmacological treatments, should be focused for older adults, and should consider comorbidities and polypharmacy, as well as psychological issues. Secondary prevention strategies include pharmacological treatments; psychosocial management; lifestyle therapy (including dietary guidelines and physical activity); cardiac rehabilitation; coronary revascularization techniques (percutaneous coronary intervention and coronary artery bypass grafting); and implantable cardioverter defibrillator therapy. For older patients, the risk-benefit ratio of each secondary prevention intervention should be considered; older patients are likely to benefit from interventions but the associated risks may be increased. Further research is needed to clarify which patients will benefit most from secondary prevention, and to clarify the strategies that will yield the greatest benefit in this age group.
"Preventive care should not be set aside simply because you're getting older," co-lead author Daniel Forman, M.D., from Brigham and Women's Hospital in Boston, said in a statement. "Care for older adults demands equally rigorous thought as for a younger person."
Several authors disclosed financial ties to the pharmaceutical industry.
Full Text (http://circ.ahajournals.org/content/early/2013/10/28/01.cir.0000436752.99896.22.full.pdf+html )