Skip to main content
SpringerLink
Log in

Coronary Artery Disease

  • Chapter
Cardiovascular Disease in the Elderly

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 135))

Abstract

The elderly as a whole are a population at risk for coronary artery disease (CAD). The elderly, defined as those individuals over 65 years of age, also represent an increasing proportion of the United States population. It is estimated that 60% of all patients hospitalized for acute myocardial infarctions (MI) are older than 65 years, and this figure is expected to increase to 80% over the next 10 years [1]. In the last 35 years, this age group has doubled to a current estimate of 28 million people, accounting for 12% of the United States population. This is projected to grow to 17% over the next 35 years; by the year 2035, the elderly will constitute 20% to 25% of the United States population [2].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. National Center for Health Statistics. 1987. 1986 Summary: National Hospital Discharge Survey. Advance Data from Vital and Health Statistics. No. 145. Hyattsville, MD: Public Health Service, p 6 (DHHS Publication No. PHS 87-1250).

    Google Scholar 

  2. Pifer A and Bronte L. 1986. Squaring the pyramid. In A Pifer and L Bronte (eds), Our Aging Society. New York: W. W. Norton, pp 3–13.

    Google Scholar 

  3. Kapantais G and Powell-Griner E. 1989. Characteristics of Persons Dying of Diseases of the Heart: Preliminary Data from the 1986 National Mortality Follow-up Survey. Hyattsville, MD: National Center for Health Statistics; Advance Data, p 172.

    Google Scholar 

  4. Goldberg RJ, Gore JM, Gurwitz JH, et al. 1989. The impact of age on the incidence and prognosis of initial acute myocardial infarction: the Worcester Heart Attack Study. Am Heart J 117:543–549.

    Article  PubMed  CAS  Google Scholar 

  5. Statson WB, Sanders CA and Smith HC. 1987. Cardiovascular care of the elderly: economic considerations. J Am Coll Cardiol 10:18A–21A.

    Article  Google Scholar 

  6. Doyle TR. 1980. Incidence of coronary heart disease, stroke, and peripheral vascular disease. In TR Dawber (ed), The Framingham Study: The Epidemiology of Atherosclerotic Disease. Cambridge, MA: Harvard University Press, pp 59–76.

    Google Scholar 

  7. Gordon T, Castelli WP, Hjortland MC, et al. 1977. Predicting coronary heart disease in the middle-aged and older persons. The Framingham Study. JAMA 238:497–499.

    Article  PubMed  CAS  Google Scholar 

  8. Kennedy RD, Andrews GR and Caird FI. 1977. Ischaemic heart disease in the elderly. Br Heart J 39:1121–1127.

    Article  PubMed  CAS  Google Scholar 

  9. Castelli WP, Wilson PW, Levy D, et al. 1989. Cardiovascular risk factors in the elderly. Am J Cardiol 63:12H–19H.

    Article  PubMed  CAS  Google Scholar 

  10. Amery A, Birkenhager W, Brixko P, et al. 1985. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet 1:1349–1354.

    Article  PubMed  CAS  Google Scholar 

  11. SHEP Cooperative Research Group. 1991. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 265:3255–3264.

    Article  Google Scholar 

  12. Assmann G and Schulte H. 1989. Diabetes mellitus and hypertension in the elderly: concomitant hyperlipidemia and coronary heart disease risk. Am J Cardiol 63:33H–37H.

    Article  PubMed  CAS  Google Scholar 

  13. Lavie CJ, Gau GT, Squires RW, et al. 1988. Management of lipids in primary and secondary prevention of cardiovascular diseases. Mayo Clin Proc 63:605–621.

    Article  PubMed  CAS  Google Scholar 

  14. Lavie CJ, O’Keefe JH, Blonde L, et al. 1990. High-density lipoprotein cholesterol. Recommendations for routine testing and treatment. Postgrad Med 87:36–44,47,51.

    CAS  Google Scholar 

  15. Denke MA and Grundy SM. 1990. Hypercholesterolemia in elderly persons: resolving the treatment dilemma. Ann Intem Med 112:780–792.

    CAS  Google Scholar 

  16. Gordon T, Castelli WP, Hjortland MC, et al. 1977. High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med 62:707–714.

    Article  PubMed  CAS  Google Scholar 

  17. Lavie CJ and Milani RV. 1991. National Cholesterol Education Program’s recommendations, and implications of “missing” high-density lipoprotein cholesterol in cardiac rehabilitation programs. Am J Cardiol 68:1087–1088.

    Article  PubMed  CAS  Google Scholar 

  18. Criqui M, Heiss G, Cohn R, et al. 1987. Triglycerides and coronary heart disease mortality. The Lipid Research Clinics Follow-up Study (abstract). CVD Epidemiol News 41:13.

    Google Scholar 

  19. Rubin SM, Sidney S, Black DM, et al. 1990. High blood cholesterol in elderly men and the excess risk for coronary heart disease. Ann Intern Med 113:916–920.

    PubMed  CAS  Google Scholar 

  20. Blankenhorn DH, Nessim SA, Johnson RL, et al. 1987. Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. Circulation 69:3233–3240.

    Google Scholar 

  21. Levy RI, Brensike JF, Epstein SE, et al. 1984. The influence of changes in lipid values induced by cholestyramine and diet on progression of coronary heart disease: results of the NHLBI Type II Coronary Intervention Study. Circulation 69:325–337.

    Article  PubMed  CAS  Google Scholar 

  22. Lipid Research Clinics Program. 1984. The lipid research clinics coronary primary prevention trial results: I. Reduction in the incidence of coronary heart disease. JAMA 251:351–364.

    Article  Google Scholar 

  23. Lipid Research Clinics Program. 1984. The lipid research clinics coronary primary prevention trial results: II. Reduction in the incidence of coronary heart disease. JAMA 251:365–374.

    Article  Google Scholar 

  24. Dayton S, Pearce ML, Hashimoto S, et al. 1969. A controlled clinical trial of a diet high in unsaturated fat: in preventing the complication of atherosclerosis. Circulation (Suppl II): II–1–II–63.

    Google Scholar 

  25. Levy D, Garrison RJ, Savage DD, et al. 1989. Left ventricular mass and incidence of coronary heart disease in an elderly cohort. The Framingham Heart Study. Ann Intern Med 110:101–107.

    PubMed  CAS  Google Scholar 

  26. Rothbaum DA. 1981. Coronary artery disease. Cardiovasc Clin 12:105–118.

    PubMed  CAS  Google Scholar 

  27. Hamby RI, Hamby B and Hoffman I. 1986. Symptomatic coronary disease for 20 or more years: clinical aspects, angiographic findings, and therapeutic implications. Am Heart J 112:65–70.

    Article  PubMed  CAS  Google Scholar 

  28. Pathy MS. 1967. Clinical presentation of myocardial infarction in the elderly. Br Heart J 29:190–199.

    Article  PubMed  CAS  Google Scholar 

  29. Labovitz A et al. 1984. Mechanical complications of acute myocardial infarction. Cardiovasc Rev Rep 5:948.

    Google Scholar 

  30. Kannel WB, Dannenberg AL and Abbot RD. 1985. Unrecognized myocardial infarction and hypertension: The Framingham Study. Am Heart J 109:581–585.

    Article  PubMed  CAS  Google Scholar 

  31. Chambers BR, Norris JW. 1986. Outcome in patients with asymptomatic neck bruits. N Engl J Med 315:860–865.

    Article  PubMed  CAS  Google Scholar 

  32. Olbrich O and Woodford-Williams E. 1953. Normal precordial electrocardiogram in aged. J Gerontol 8:40–55.

    Article  PubMed  CAS  Google Scholar 

  33. Campbell A, Caird FI and Jackson TFM. 1974. Prevalence of abnormalities of electrocardiogram in old people. Br Heart J 36:1005–1011.

    Article  PubMed  CAS  Google Scholar 

  34. Vasilomanolakis E, Damian A, Mahan G, et al. 1984. Treadmill stress testing in geriatric patients (abstract). J Am Coll Cardiol 3:520.

    Google Scholar 

  35. Lavie CJ, Ventura HO and Murgo JP. 1991. Assessment of stable ischemic heart disease. Which tests for which patients? Postgrad Med 89:44–50,57–60,63.

    PubMed  CAS  Google Scholar 

  36. Coyne E, Belveder D, Streek P, et al. 1991. Thallium-201 scintigraphy after intravenous infusion of adenosine compared with thallium testing in the diagnosis of coronary artery disease. J Am Coll Cardiol 17:1289–1294.

    Article  PubMed  CAS  Google Scholar 

  37. The Norwegian Multicenter Study Group. 1981. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 304:801–807.

    Article  Google Scholar 

  38. Hjalmarson Å, Herlitz J, Málek I, et al. 1981. Effect on mortality of metoprolol in acute myocardial infarction: a double-blind randomized trial. Lancet 2:823–827.

    Article  PubMed  CAS  Google Scholar 

  39. ß-blocker Heart Attack Study Group. 1981. The ß-blocker Heart Attack Trial. JAMA 246:2073–2074.

    Article  Google Scholar 

  40. Lichstein E, Hager WD, Gregory JJ, et al. 1990. Relation between beta-adrenergic blocker use, various correlates of left ventricular function and the chance of developing congestive heart failure. The Multicenter Dilitazem Post-Infarction Research Group. J Am Coll Cardiol 16:1327–1332.

    Article  PubMed  CAS  Google Scholar 

  41. Staessen J, Fagard R, Van Hoof R, et al. 1988. Mortality in various intervention trials in elderly hypertensive patients: a review. Eur Heart J 9:215–222.

    PubMed  CAS  Google Scholar 

  42. Wikstrand J, Warnold I, Tuomilehto J, et al. 1991. Metoprolol versus thiazide duretics in hypertension. Morbidity results from the MAPHY Study. Hypertension 17:579–588.

    Article  PubMed  CAS  Google Scholar 

  43. Olsson G, Tuomilehto J, Berglund G, et al. 1991. Primary prevention of sudden cardiovascular death in hypertensive patients. Mortality results from the MAPHY Study. Am J Hypertens 4(2, Part 1):151–158.

    PubMed  CAS  Google Scholar 

  44. Feely J, Wilkinson GR and Wood AJJ. 1981. Reduction of liver flow and propranolol metabolism by Cimetidine. N Engl J Med 304:692–695.

    Article  PubMed  CAS  Google Scholar 

  45. Chiariello M, Volpe M, Rengo F, et al. 1979. Effect of furosemide on plasma concentration and ß-blockade by propranolol. Clin Pharmacol Ther 26:433–436.

    PubMed  CAS  Google Scholar 

  46. McLean AJ, Skews H, Bobik A, et al. 1980. Interaction between oral propranolol and hydralazine. Clin Pharmacol Ther 27:726–732.

    Article  PubMed  CAS  Google Scholar 

  47. Pieper JA. 1984. Serum protein binding interactions between propranolol and calcium channel blockers (abstract). Drug Intell Clin Pharm 18:492.

    Google Scholar 

  48. Choong CY, Roubin GS, Harris PJ, et al. 1986. A comparison of the effects of beta-blockers with and without intrinsic sympathomimetic activity on hemodynamics and left ventricular function at rest and during exercise in patients with coronary artery disease. J Cardiovasc Pharmacol 8:441–448.

    Article  PubMed  CAS  Google Scholar 

  49. Griffin SJ and Freidman MJ. 1986. Depressive symptoms in propranolol users. J Clin Psychiatr 47:453–457.

    CAS  Google Scholar 

  50. Westerlund A. 1985. Central nervous system side-effects with hydrophilic and lipophilic beta blockers. Eur J Clin Pharmacol 28 (Suppl):73–76.

    Article  PubMed  Google Scholar 

  51. Greenblatt DJ and Koch-Weser J. 1973. Adverse reactions to propranolol in hospitalized medical patients: a report from the Boston Collaborative Drug Surveillance Program. Am Heart J 86:478–484.

    Article  PubMed  CAS  Google Scholar 

  52. Frishman WH, Charlap S, Rimmel B, et al. 1986. Calcium-channel blockers for combined angina pectoris and systemic hypertension. Am J Cardiol 57:22D–29D.

    Article  PubMed  CAS  Google Scholar 

  53. Abernethy DR, Schwartz JB, Todd EL, et al. 1986. Verapamil pharmacodynamics and disposition in young and elderly hypertensive patients. Altered electrocardiographic and hypotensive responses. Ann Intern Med 105:329–336.

    PubMed  CAS  Google Scholar 

  54. Morselli P, Rovel V, Mitchard M, et al. 1979. Pharmacokinetics and metabolism of diltiazem on man (observations on healthy volunteers and angina pectoris patients). In RJ Bing (ed), New Drug Therapy With a Calcium Antagonist: Diltiazem. Hakone Symposium 1978. Amsterdam: Excerpta Medica, pp 152–167.

    Google Scholar 

  55. The Israeli SPRINT Study Group. 1988. Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT). A randomized intervention trial of nifedipine in patients with acute myocardial infarction. Eur Heart J 9:354–364.

    Google Scholar 

  56. Lavie CJ and Gersh BJ. 1990. Acute myocardial infarction: initial manifestations, management, and prognosis. Mayo Clin Proc 65:531–548.

    Article  PubMed  CAS  Google Scholar 

  57. Lavie CJ, Murphy JG and Gersh BJ. 1988. The role of beta-receptor and calcium-entry-blocking agents in acute myocardial infarction in the thrombolytic era: can the results of thrombolytic reperfusion be enhanced? (Editorial.) Cardiovasc Drugs Ther 2:601–607.

    Article  PubMed  CAS  Google Scholar 

  58. Elkayam U, Amin J, Mehra A, et al. 1990. A prospective, randomized, double-blind, crossover study to compare the efficacy and safety of chronic nifedipine therapy with that of isosorbide dinitrate and their combination in the treatment of chronic congestive heart failure. Circulation 82:1954–1961.

    Article  PubMed  CAS  Google Scholar 

  59. The Multicenter Diltiazem Postinfarction Trial Research Group. 1988. The effect of diltiazem on mortality and reinfarction after myocardial infarction. N Engl J Med 319: 385–392.

    Article  Google Scholar 

  60. Danish Study Group on Verapamil in Myocardial Infarction. 1990. Secondary prevention with verapamil after myocardial infarction. Am J Cardiol 66:331–401.

    Google Scholar 

  61. Gibson RS, Boden WE, Theroux P, et al. 1986. Diltiazem and reinfarction in patients with non-Q-wave myocardial infarction. Results of a double-blind, randomized trial. N Engl J Med 315:423–429.

    Article  PubMed  CAS  Google Scholar 

  62. The Danish Study Group on Verapamil in Myocardial Infarction. 1990. Effect of verapamil on mortality and major events after acute myocardial infarction. (The Danish Verapamil Infarction Trial II-DAVIT II.) Am J Cardiol 66:779–785.

    Article  Google Scholar 

  63. Lavie CJ, Ventura HO and Messerli FH. 1991. Regression of increased left ventricular mass by antihypertensives. Drugs 42:945–961.

    Article  PubMed  CAS  Google Scholar 

  64. Lavie CJ, Milani RV and Messerli FH. 1991. How antihypertensives affect lipid levels. Intern Med 12:36–46.

    Article  Google Scholar 

  65. Messerli FH, Nunez BD, Nunez MM, et al. 1989. Hypertension and sudden death. Disparate effects of calcium entry blocker and diuretic therapy on cardiac dysrhythmias. Arch Intern Med 149:1263–1267.

    Article  PubMed  CAS  Google Scholar 

  66. Marchionni N, Schneeweiss A, Di Bari M, et al. 1988. Age-related hemodynamic effects of intravenous nitroglycerin for acute myocardial infarction and left ventricular failure. Am J Cardiol 6161:81E-83E.

    Article  Google Scholar 

  67. Reisen LH, Landau E, Darawshi A. 1988. More rapid relief of pain with isosorbide dinitrate oral spray than with sublingual tablets in elderly patients with angina pectoris. Am J Cardiol 61:2E–3E.

    Google Scholar 

  68. Come PC and Pitt B. 1976. Nitroglycerin-induced severe hypotension and bradycardia in patients with acute myocardial infarction. Circulation 54:624–628.

    Article  PubMed  CAS  Google Scholar 

  69. Lavie CJ and Gersh BJ. 1990. Mechanical and electrical complications of acute myocardial infarction. Mayo Clin Proc 65:709–730.

    Article  PubMed  CAS  Google Scholar 

  70. Herrick JB. 1912. Certain clinical features of sudden obstruction of the coronary arteries. Trans Assoc Am Phys 27:100.

    Google Scholar 

  71. Sherman CT, Litvack F, Grunfest W, et al. 1986. Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med 315:913–919.

    Article  PubMed  CAS  Google Scholar 

  72. DeWood MA, Spores J, Notske R, et al. 1980. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med 303:897–902.

    Article  PubMed  CAS  Google Scholar 

  73. Davies MJ and Thomas A. 1984. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med 310:1137–1140.

    Article  PubMed  CAS  Google Scholar 

  74. White C, Ramee S, Mesa J, et al. 1990. Percutaneous coronary angioscopy in stable and unstable angina. Circulation 82 (Suppl III):III–677.

    Google Scholar 

  75. Lavie CJ and Genton E. 1991. Hemostasis, thrombosis, and antiplatelet therapy: implications for prevention of cardiovascular diseases. Cardiovasc Rev Rep 12:24–44.

    Google Scholar 

  76. Steering Committee of the Physicians’ Health Study Research Group. 1989. Final report on the aspirin component of the ongoing physicians health study. N Engl J Med 321:129–135.

    Article  Google Scholar 

  77. Peto R, Gray R, Collins R, et al. 1988. Randomised trial of prophylactic daily aspirin in British male doctors. Br Med J 296:313–316.

    Article  CAS  Google Scholar 

  78. Klimt CR, Knatterud GL, Stamler J, et al. 1986. Persantine-aspirin Reinfarction Study. Part II. Secondary coronary prevention with persantine and aspirin. J Am Coll Cardiol 7: 251–269.

    Article  PubMed  CAS  Google Scholar 

  79. McTavish D, Faulds D and Goa KL. 1990. Ticlodipine. An updated review of its pharmacology and therapeutic use in platelet-dependent disorders. Drugs 40:238–259.

    Article  PubMed  CAS  Google Scholar 

  80. A double-blind trial to assess long-term oral anticoagulant therapy in elderly patients after myocardial infarction. Report of the sixty plus Reinfarction Study Research Group. 1980. Lancet 1:989–993.

    Google Scholar 

  81. Brown G, Albers JJ, Fisher LD, et al. 1990. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 323:1289–1298.

    Article  PubMed  CAS  Google Scholar 

  82. Cashin-Hemphill L, Mack WJ, Pogoda JM, et al. 1990. Beneficial effects of colestipol-niacin on coronary atherosclerosis. A 4-year follow-up. JAMA 264:3013–3017.

    Article  PubMed  CAS  Google Scholar 

  83. Buchwald H, Varco RL, Matts JP, et al. 1990. Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia. Report of the Program on the Surgical Control of the Hyperlipidemias (POSCH). N Engl J Med 323:946–955.

    Article  PubMed  CAS  Google Scholar 

  84. The Expert Panel. 1988. Report of the National Cholesterol Education Program on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Arch Intern Med 148:36–69.

    Article  Google Scholar 

  85. O’Keefe J, Lavie CJ and O’Keefe J. 1989. Dietary prevention of coronary artery disease. Postgrad Med 85:243–261.

    PubMed  Google Scholar 

  86. Milani R and Lavie C. 1991. Benefits of secondary coronary prevention in the elderly (abstract). Circulation 84 (Suppl II):II–221.

    Google Scholar 

  87. Lavie CJ and Milani RV. 1991. Benefits of cardiac rehabilitation and exercise training in the elderly (abstract). J Am Coll Cardiol 19:377A.

    Google Scholar 

  88. Frick MH, Elo O, Haapa K, et al. 1987. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia: safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med 317:1237–1245.

    Article  PubMed  CAS  Google Scholar 

  89. DeBakey ME. 1989. Surgical treatment of atherosclerotic heart disease. Am J Cardiol 63:9H–11H.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Andrew P. Rees
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carl J. Lavie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carl J. Pepine
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana, USA

    Franz H. Messerli

Rights and permissions

Reprints and permissions

Copyright information

© 1993 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Rees, A.P., Lavie, C.J., Pepine, C.J. (1993). Coronary Artery Disease. In: Messerli, F.H. (eds) Cardiovascular Disease in the Elderly. Developments in Cardiovascular Medicine, vol 135. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-3516-4_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-3516-4_12

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-6560-0

  • Online ISBN: 978-1-4615-3516-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation