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ASCVD in Older Adults

ASCVD in Older Adults

About a decade ago, the American Heart Association (AHA) released an initial scientific statement on secondary prevention of atherosclerotic cardiovascular disease (ASCVD) for older patients, but there has been an explosion of studies addressing the treatment of hypertension, hyperlipidemia, diabetes, and antithrombotic therapy since that publication. AHA updated this scientific statement in 2013 to further clarify risks and benefits of secondary prevention in older adults. The statement, published in Circulation, is also intended to stimulate greater use of proven therapies for these patients. “Secondary prevention lifestyle changes may seem inappropriate in the context of advanced age, but they have the potential to improve function, quality of life, and functional independence,” explains Jerome L. Fleg, MD, who co-chaired the writing group that developed the AHA update. “Therefore, these changes should be actively considered for many older patients with ASCVD.” Addressing Challenges The proportion of adults older than 75 in most cardio-vascular trials is low, according to the AHA update. Furthermore, the patients enrolled are often healthier than elders in the community due to the desire of investigators to avoid the potential effects of comorbidities on trial outcomes. Consequently, generalizing the results of these trials to typical older patients is challenging. In addition, many older patients are not receiving evidence-based secondary prevention care. Comorbidities, polypharmacy, socioeconomic stresses, and cognitive limitations can also complicate how secondary prevention for ASCVD is utilized in older adults.   Per the recommendations, secondary preventive care for ASCVD should be personalized in patients aged 75 and older, given their wide range of comorbidities, lifestyles, and functional status. When not contraindicated, b-blockers, aspirin, and statins are recommended to...
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