Systolic BP increase with age, diastolic BP declines thereafter • Pulse pressure (the
difference between systolic and diastolic BP) increases with age,
systolic hypertension dominant form of hypertension in older adults, especially women •
increased diastolic BP raises CVD risk independent of systolic BP, particularly in men
DIABETES MELLITUS
• Prevalence increases with age at least up to age 80 • Approx. 50% of pts with
diabetes in the US are ≥65 yr old • As in younger patients, the impact of diabetes on
CVD risk is greater in older women than in older men • In the Framingham Heart Study,
for example: • The adjusted risk for incident CHD for older patients with diabetes was
, 2.1 in women and 1.4 in men • The excess risk associated with diabetes was greater in
both men and women >65 yr old than in younger individuals
DYSLIPIDEMIA
• The strength of the association between total cholesterol and LDL cholesterol levels
and incident CAD ↓ with age, especially after age 80 • But low HDL cholesterol levels
(<40 mg/dL in men, <50 mg/dL in women) and high ratios of total cholesterol to HDL
cholesterol (≥5.5 in men, ≥5 in women) remain independently associated with coronary
events even among people >80 yr old • Clinical trials have demonstrated benefits of
statin therapy in moderate-risk and high-risk patients up to 85 yr of age
SMOKING
• Prevalence of smoking declines with age, partly due to successful smoking cessation,
partly due to premature deaths in smokers • Among older smokers, smoking cessation
is associated with substantial reductions in CVD risk within 2−6 years relative to
continued smoking • In most studies, smoking remains a strong and independent risk
factor for fatal and nonfatal CV events among older adults
ADDITIONAL RISK FACTORS?
Whether the following are important risk factors for CVD among older adults is unclear: •
Obesity • Increased levels of C-reactive protein, fibrinogen, D-dimer, and plasmin-
antiplasmin complex • Coronary artery calcium content on CT
ACUTE CORONARY SYNDROMES
The acute coronary syndromes (ACS): • Unstable angina • Non-ST-elevation MI
(NSTEMI) • ST-elevation MI (STEMI)
ACS: PRESENTATION
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