Exercise therapy for older persons with cardiovascular disease

Cardiac rehabilitation with exercise training after myocardial infarction in persons younger than 70 years has been found to cause a significant decrease in all-cause mortality, cardiovascular mortality, and fatal reinfarction, but no significant difference in nonfatal reinfarction. After myocardial infarction or coronary revascularization in older individuals, such programs significantly improve physical work capacity, body mass index, percent body fat, serum lipids, behavioral characteristics, and quality of life. Exercise modalities should include aerobic, resistance, and flexibility exercises. Less intense exercise of longer duration should be performed by older persons with coronary artery disease. Exercise training programs in patients with congestive heart failure produce significant improvement in peak oxygen consumption, exercise duration, and power output. The benefits of exercise training in patients with congestive heart failure may be due to an increase in cardiac output, an improvement in skeletal muscle metabolism, and an increase in peak blood flow to the exercising limb caused by a reduction in vascular resistance.     

Coronary artery disease is more severe in older persons with rheumatoid arthritis than in older persons without rheumatoid arthritis

We investigated the severity of coronary artery disease (CAD) diagnosed by coronary angiography performed because of suspected CAD in 102 persons, mean age 68 years, with rheumatoid arthritis (RA) and in 102 age-matched and sex-matched persons. CAD was diagnosed by coronary angiography in 80 of 102 persons (78%) with RA and in 79 of 102 persons (77%) without RA (P not significant). Three-vessel CAD was present in 31 of 102 persons (30%) with RA and in 8 of 102 persons (8%) without RA (P < 0.001). Coronary revascularization was performed in 71 of 102 persons (70%) with RA and in 23 of 102 persons (23%) without RA (P < 0.001). Older persons with RA with suspected CAD have a higher prevalence of 3-vessel CAD and a higher prevalence of coronary revascularization than age-matched and sex-matched persons with suspected CAD without RA.     

Caries prevalence in older persons with and without dementia

OBJECTIVES: To examine the prevalence of coronal and root caries in a memory clinic–based population of elderly patients with and without a diagnosis of dementia and to examine the influence of age, sex, social relations, social position, and functional ability.
DESIGN: Cross-sectional.
SETTING: Patients referred with possible cognitive dysfunction were recruited from two university hospital dementia clinics.
PARTICIPANTS: In total, 106 dentate persons participated in the study. Mean age was 82, 69 were women, and 87 had a diagnosis of dementia.
MEASUREMENTS: Data from interviews and a clinical examination were collected. The diagnosis of dementia was made at the dementia clinics according to the criteria of International Classification of Diseases, Tenth Revision . Active coronal and root caries was assessed using previously defined diagnostic criteria from the National Institute of Dental and Craniofacial Research.
RESULTS: The mean number of coronal and root surfaces with caries was statistically significantly higher in subjects with a diagnosis of dementia (7.0 vs 2.7, P <.05). Subjects with a diagnosis of Alzheimer's disease had a significantly higher mean number of root surfaces with caries (4.9, P <.05) than subjects with other dementia diagnoses (2.3) and those without dementia (1.7). People with Alzheimer's disease also had significantly more mean total caries than subjects without dementia (7.8 vs 2.7, P <.05). Participants with a Mini-Mental State Examination (MMSE) score less than 24 had significantly more caries than participants with a MMSE-score of 24 or higher (7.6 vs 4.3, P <.05).
CONCLUSION: Patients with newly diagnosed dementia already had a high level of active dental caries when they were referred to the memory clinic. The high caries prevalence was related to dementia type and severity.     

Quantitative retinal venular caliber and risk of cardiovascular disease in older persons: the cardiovascular health study

BACKGROUND: Small vessel disease may contribute to the risk of cardiovascular disease in older persons. We describe the relation of retinal vascular caliber to incident coronary heart disease (CHD) and stroke in elderly persons. METHODS: Prospective population-based cohort study composed of 1992 men and women aged 69 to 97 years living in 4 US communities. Retinal arteriolar and venular calibers were measured from retinal photographs using a computer-assisted method. Incident CHD and stroke events were ascertained using standardized methods. RESULTS: After 5 years of follow-up, there were 115 incident CHD events and 113 incident stroke events. Participants with larger retinal venular caliber had a higher incidence of CHD (11.7%; 95% confidence interval [CI], 8.7%-15.8%, vs 8.1%; 95% CI, 5.7%-11.6%), comparing largest with smallest venular caliber quartiles, and stroke (8.4%; 95% CI, 6.0-11.7, vs 5.8%; 95% CI, 3.9-8.4). At multivariable analysis, controlling for age, sex, race, arteriolar caliber, systolic and diastolic blood pressure, diabetes, glucose concentration, cigarette smoking, pack-years of smoking, and high-density-lipoprotein and low-density lipoprotein cholesterol levels, larger retinal venular caliber was associated with incident CHD (rate ratio, 3.0; 95% CI, 1.6-5.7, comparing largest with smallest venular caliber quartiles; P(trend) = .001) and incident stroke (rate ratio, 2.2; 95% CI, 1.1-4.3; P(trend) = .02). Additional adjustment for C-reactive protein and common and internal carotid artery intimal-media thickness had minimal effect on these associations. At multivariable analysis, smaller retinal arteriolar caliber was associated with incident CHD (rate ratio, 2.0; 95% CI, 1.1-3.7, comparing largest with smallest arteriolar caliber quartiles; P = .03) but not stroke (rate ratio,1.1; 95% CI, 0.5-2.2; P = .73). CONCLUSION: Larger retinal venular caliber is independently associated with risk of cardiovascular disease in elderly persons.     

Exercise rehabilitation of older patients with cardiovascular disease

As the population of elderly patients with cardiovascular disease continues to increase, much research needs to be done with the goal of maintaining physical functioning and personal independence in this population. It is of particular importance to determine whether training programs can improve physical functioning in the most severely disabled older coronary patients. Effects of cardiac rehabilitation programs on other outcome measures, including psychosocial outcomes, lipid levels, insulin levels, and body composition require better study. Finally, the economic benefits of cardiac rehabilitation in the older coronary patients has received little attention, although early reports are promising. In summary, the older population with coronary disease is characterized by high rates of disability. Exercise training has been demonstrated to be safe and to improve strength, aerobic fitness capacity, endurance and physical function. It remains to be seen whether exercise training can reverse or prevent disability in a broad population of older patients with cardiovascular disease. If successful, cardiac rehabilitation programs will pay great medical, social, and economic dividends in this population.     

Incidence of heart failure in 2,737 older persons with and without diabetes mellitus

STUDY OBJECTIVES: To investigate in older persons whether diabetes mellitus is an independent risk factor for congestive heart failure (CHF). DESIGN: A prospective study was performed in 2,737 older persons investigating the incidence of new CHF in persons with and without diabetes mellitus. SETTING: A long-term health-care facility. PATIENTS: Eight hundred sixty-five men and 1,872 women, with a mean age of 81+/-9 years. MEASUREMENTS AND RESULTS: At 43-month follow-up, new CHF developed in 272 of 690 persons (39%) with diabetes mellitus and in 467 of 2,047 persons (23%) without diabetes mellitus (p < 0.0001). Cox regression analysis showed that age (p = 0.0001, risk ratio = 1.048), hypertension (p = 0.0001, risk ratio = 2.524), coronary artery disease (p = 0.0001, risk ratio = 4.008), male gender (p = 0.0001, risk ratio = 1.399), and diabetes mellitus (p = 0.0003, risk ratio = 1.337) were significantly positively associated with the time to the development of CHF. CONCLUSIONS: Older persons with diabetes mellitus had a 1.3 times higher chance of developing CHF than those without diabetes mellitus after controlling the confounding effects of other prognostic variables.     

Treatment of dyslipidemia in pre- and postmenopausal women with and without known atherosclerotic cardiovascular disease

Cardiovascular disease is the primary cause of death among women in the United States, in part due to a very high prevalence of dyslipidemia. Clinical trials have shown that low-density lipoprotein cholesterol-lowering therapy can decrease angiographic progression of coronary disease and decrease clinical events among women and men. Although hormone replacement therapy has beneficial effects on the lipoprotein profile, its role in cardiovascular disease prevention remains unclear. The recently released Third Report of the National Cholesterol Education Program Expert Panel provides detailed guidelines for the management of dyslipidemia in women, with a focus on low-density lipoprotein cholesterol and intensity guided by risk of cardiovascular events.     

Shared decision-making for older adults with cardiovascular disease

Shared decision-making is appropriate for clinical decisions involving multiple reasonable options, which occur frequently in the cardiovascular care of older adults. The process includes the communication of relevant factual information between the patient and the clinician, elicitation of patient preferences, and a mutual agreement on the best course of action to meet the patient's personal goals. For older adults, there are common challenges and considerations with regard to shared decision-making, some of which (eg, cognitive impairment) may be biologically linked to cardiovascular disease. There are tools designed to facilitate the shared decision-making process, known as decision aids, which are broadly effective although have shortcomings when applied to older adults. Novel approaches in clinical research and health systems changes will go some way toward improving shared decision-making for older adults, but the greatest scope for improvement may be within the grass roots areas of communication skills, interdisciplinary teamwork, and simply asking our patients what matters most.     

Relationship between ambulation and obesity in older persons with and without low back pain

CONTEXT: For obese older persons, ambulation is both functionally important and a means of weight control. The relationship between weight and ambulation is not known in this population. Also, the extent to which pain interferes with ambulation is not studied. OBJECTIVE: To examine the relationship between obesity and ambulation, and to determine the effect of pain and body mass index (BMI) on ambulation in older persons. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of 82 older persons, ages 55-79 y, some with no back pain recruited from the community, others with back pain or spinal stenosis recruited from a magnetic resonance imaging (MRI) scanner as part of a larger university study of spinal stenosis. OUTCOME MEASURES: Age, Visual Analog Scales for pain, BMI, patient diagnosis (no pain, mechanical back pain, and spinal stenosis), walking velocity and stride length on a 15-min laboratory ambulation test, and 1-week community ambulation measured with a pedometer (steps, distance, and energy expenditure). RESULTS: BMI had a significant inverse relationship with ambulatory measurements in terms of the distance walked, steps taken, and walking velocity. Pain severity and pain category also had a significant inverse relationship with these measures. A negative correlation was observed between pain and obesity, although the relationship was statistically nonsignificant. DISCUSSION: Obese older people walked less than the nonobese older people. Pain was associated with decreased ambulation. Clinicians who intend to encourage increased ambulation in older obese persons should consider possible barriers posed by musculoskeletal pain.     

辛伐他汀对血脂异常人群缺血性脑卒中的预防

目的研究辛伐他汀对血脂异常人群缺血性脑卒中的预防作用。方法将2853例血脂异常人群分为预防组(693例)和对照组(2160例),预防组给予辛伐他汀20mg/d,睡前口服。分析2组血脂变化、心脑血管事件、脑卒中等差异。结果预防组受试者糖尿病患病率比对照组高,预防组随访率98．7%,对照组随访率96．2%。预防组低密度脂蛋白胆固醇较对照组低[(2．54±1．01)mmol/L vs(4．12±1．29)mmol/L,P＜0．05],5年生存率高(94．13% vs 83．47%,P＜0．01),缺血性脑卒中和心脑血管事件发生率低。2组死亡的主要原因是:心脑血管疾病、肿瘤和感染。吸烟、高血压、肥胖和糖尿病是脑卒中和心脑血管事件的高危因素。结论辛伐他汀能有效降低血脂异常人群的心脑血管事件。     

Resilience among older cardiovascular disease patients with probable sarcopenia

Aim and objectivesThe purpose of this study was to investigate the factors associated with resilience among probable sarcopenia older adults with cardiovascular disease.IntroductionResilience has been reported to be positively correlated with the mental health and physical functioning of older adults. Previous research has found that the development of resilience constitutes a form of compensation for loss of physical health. It is important for older adults, especially those with other underlying conditions, such as cardiovascular disease and sarcopenia, to have the ability to overcome adversity during the aging process. Thus, resilience becomes a critical characteristic in achieving a better life.MethodsA cross-sectional study design was used. A demographic questionnaire and the Chinese version of the Resilience Scale (CRS) were used to collect data. Multiple logistic regression was used to evaluate the predictors of low resilience.ResultsA total of 267 participants were recruited, including 126 females and 141 males. Of the participants, 56% of their scores indicated low resilience. Income, education level, exercise time, primary caregiver, and having hypertension were the predictors of resilience.ConclusionThe population with sarcopenia is increasing worldwide. Understanding resilience levels among older adults with probable sarcopenia is essential for promoting their mental health. Clinicians can use the results of this study to identify populations at high risk for low resilience and design specific interventions to promote better health outcomes.