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Epidemiology of CVD in the Elderly

Epidemiology of CVD in the Elderly. Karen P. Alexander MD Duke University Medical Center Duke Clinical Research Institute. Disclosures: (1) Minor Research: Schering Plough, Merck (2) Consultant: Gilead . Prevalence of CVD by Age and Sex (NHANES 2003-2006). CVD = CHD, CHF, Stroke.

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Epidemiology of CVD in the Elderly

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  1. Epidemiology of CVD in the Elderly Karen P. Alexander MD Duke University Medical Center Duke Clinical Research Institute Disclosures: (1) Minor Research: Schering Plough, Merck (2) Consultant: Gilead

  2. Prevalence of CVD by Age and Sex(NHANES 2003-2006) CVD = CHD, CHF, Stroke POPULATION (%) AGE (yrs) REF: Heart Disease and Stroke Statistics- 2010 Update; Circulation 2010:121;e46-e215

  3. #1 Heart Disease #2 Cancer #3 Stroke #4 COPD/Lung #5 Alzheimer's

  4. Increase in the Oldest OldU.S. Population Aged 85+ (millions) REF: U.S. Census Bureau, “We the American Elderly,” 1993.

  5. Age 75 →11.7 yrs Age 85 →6.6 yrs Age 90 →4.8 yrs Consider that in most CHD outcome studies, “long-term” follow up is 3-5 years.

  6. Chronic Health Conditions Trouble Hearing 40% Trouble Seeing Cognitive Impairment 13% 20% REF: Health and Retirement Survey, CDC National Health Interview Survey, CHS Fried, J Geront Biol Sci 2001

  7. Older Adults: Disability Canadian Study of Health and Aging 9,008 Community Dwelling Seniors Basic (physical) and Instrumental (functional) ADLs Cause of Disability #1 Arthritis #2 Foot Problems #3 Heart Disease #4 Vision Problems #5 Cognitive Impairment REF: Griffith L, et al. Age and Ageing 2010;39:738-745

  8. Resource Use – CVD Dx Codes 2006 79 million office visits 4 million ED visits 6 million hospitalizations 7 million procedures 503 billion dollars direct and indirect costs REF: Lloyd-Jones D, et al. Heart and Stroke Statistics- 2010 Update. Circulation 2010;121;e46-e215

  9. Cardiovascular Health Study • 5,888 Participants Age ≥65 years (1989-1990) • Mean Age 72.8 yr • HTN (58%), DM (16%), Smoking (12%) • Prior MI (10%), Stroke (4%), HF (5%) • Mean Total Chol = 211 mg/dL • Medications • Lipid lowering (6%), Antihypertensive (47%) • Semiannual contact- 10 years of follow up REF: Arnold AM, et al, JAGS 2005;53:211-218

  10. Incidence of Heart Disease Caucasian Male: 10 year follow up Rate/1,000 Person-Years Age (Yrs) CHD = Fatal and Non-fatal MI, Angina, coronary revascularization REF: Arnold AM, et al, JAGS 2005;53:211-218

  11. Incidence of Stroke Caucasians: 10 year follow up Rate/1,000 Person-Years Age (Yrs) REF: Arnold AM, et al, JAGS 2005;53:211-218

  12. INTERHEART: RF for First MICase- Control of Acute MI Population Attributable Risk 93.9% 87.9% * Old = Men >55 yrs; Women >65 yrs REF: Yusuf et al, Lancet 2004;364:937-52

  13. Healthy People 2010 • Goal: Lower CHD mortality by 20% by 2010 • Risk Factor Population Targets • Mean TC 199 mg/dL • Smoking 12% • HTN 16% • DM 6% • Obesity 15% • Inactivity 20% REF: http://www.cdc.gov/nchs/hphome.htm

  14. Trends in Risk Factors*The good news Cholesterol Smoking HP 2010 HP 2010 * Linear Time Plots based on NHANES 1988-1994 and NHANES 1999-2002 REF: Capewell S, Bulletin WHO 2010;88:120-130

  15. Trends in Risk FactorsThe bad news BMI Systolic Blood Pressure REF: Capewell S, Bulletin WHO 2010;88:120-130

  16. Estimated Reduction in CHD Deaths by Risk Factor ModificationsThree Scenarios BMI Physical Activity Diabetes Smoking Systolic BP Cholesterol Reduction in Deaths from CHD REF: Capewell S, Bulletin WHO 2010;88:120-130

  17. Estimated Reduction in CHD Deaths by AgeThree Risk Factor Scenarios Age Group 45-54 55-64 65-74 75-84 Reduction in Deaths from CHD REF: Capewell S, Bulletin WHO 2010;88:120-130

  18. Prevalence of HBP in Adults (NHANES 2003-2006) POPULATION (%) AGE (yrs) REF: Heart Disease and Stroke Statistics- 2010 Update; Circulation 2010:121;e46-e215

  19. Hypertension in the ElderlyFramingham Cohort Prevalence of HTN Control of HTN MEN WOMEN MEN WOMEN REF: Lloyd-Jones et al, JAMA 2005;294:466-472

  20. Conclusions • CVD is the leading cause of death • Incidence increases with age • CVD >men; CHF equal; Stroke >women • Risk factors contribute to new events • explaining up to 85% of PAR for first MI • Improvements in Chol and HTN offset by worsening obesity and DM • Long way to go for Healthy People 2010 Goals • BP is poorly controlled relative to guidelines, especially among older women • HTN may explain up to 25% of new events

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