Coronary Heart Disease and Stroke
Although at declining incidence, cardiovascular diseases still represent the leading causes of death in the Western world, and myocardial infarction occupies the largest share within these deaths. In 2006, 26% of all 2,426,264 deaths in the United States
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Relevance for Elderly Patients, Epidemiology Although at declining incidence, cardiovascular diseases still represent the leading causes of death in the Western world, and myocardial infarction occupies the largest share within these deaths. In 2006, 26% of all 2,426,264 deaths in the United States resulted from cardiac diseases, 23% from malignant diseases; 6% were caused by cerebrovascular diseases. Cardiac deaths had a male/female ratio of 1.5. From 1999 to 2006, there was a decline of the total annual death rate from cardiac disease from 260 to 211 per 100,000 inhabitants. This rate is 207 at age 55–64 years and rises to 1,383 at age 75–84 years and even to 4,480 at age 85+ years (Heron et al. 2009). This indicates that although cardiac diseases as a major cause of death are on the decline, the immense increase at higher age is an important feature of aging societies. The life expectancy at birth in 2006 was 75 years for males, 80 years for females, with the difference mainly reflecting the underrepresentation of women in the incidence of cardiac disease. These numbers clearly underline the paramount importance of prevention and treat-
M. Wehling (*) University of Heidelberg, Maybachstr. 14, Mannheim 68169, Germany e-mail: [email protected]
ment of cardiac disease, which is mainly myocardial infarction, in the elderly. The epidemiology of cerebrovascular disease mainly representing stroke is analogous: From 1999 to 2006, there was a decline of the total annual death rate from cerebrovascular disease from 60 to 46 per 100,000 inhabitants; this rate was 33 at age 55–64 years and rose to 335 at age 75–84 years and even to 1,040 at age 85+ years (Heron et al. 2009). The age-related increase from 55–64 to 85+ years thus is even greater (32-fold) than for myocardial infarction (22fold). In the following chapters, practically relevant features of chronic treatment in the elderly should be emphasized; the special intensive care modalities for acute disease are not comprehensively discussed. As chronic treatment of myocardial infarction includes the pharmacological protection of viable myocardium, while chronic stroke treatment mainly addresses the control of risk factors (hypertension, atrial fibrillation) and rehabilitation, stroke is only briefly mentioned here. Treatment of arterial hypertension as the most important preventive measure against stroke, and its recurrence is discussed in chapter “Arterial Hypertension”, atrial fibrillation in chapter “Atrial Fibrillation”. Lipid therapy and platelet inhibition for stroke prevention are not essentially different from treatment of coronary heart disease (CHD) and are thus covered here.
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_8, # Springer-Verlag Wien 2013
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Therapeutically Relevant Special Features of Elderly Patients The pathophysiology of myocardial infarction is not essentially different in elderly and younger patients. The incidences of related deaths are, however, very different (see previous dis
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