Management of Stable Angina in the Older Adult Population

Abstract

As society ages, the number of older adults with stable ischemic heart disease continues to rise. Older adults exhibit the greatest morbidity and mortality from stable angina. Furthermore, they suffer a higher burden of comorbidity and adverse events from treatment than younger patients. Given that older adults were excluded or underrepresented in most randomized controlled trials of stable ischemic heart disease, evidence for management is limited and hinges on subgroup analyses of trials and observational studies. This review aims to elucidate the current definitions of aging, assess the overall burden and clinical presentations of stable ischemic heart disease in older patients, weigh the available evidence for guideline-recommended treatment options including medical therapy and revascularization, and propose a framework for synthesizing complex treatment decisions in older adults with stable angina. Due to evolving goals of care in older patients, it is paramount to readdress the patient’s priorities and preferences when deciding on treatment. Ultimately, the management of stable angina in older adults will need to be informed by dedicated studies in representative populations emphasizing patient-centered end points and person-centered decision-making.

Shorter Dual Antiplatelet Therapy for Older Adults After Percutaneous Coronary Intervention

“…Older adults have been variably defined as 65 years of age or older to 75 years of age or older depending on the literature source, have more complex coronary anatomy, and are at the highest risk for future cardiovascular events, while simultaneously having the highest risk for bleeding complications. [3][4][5] Despite the distinct anatomical and clinical risk factors and their potential implications for adverse outcomes associated with purinergic receptor P2Y, G-protein-coupled, 12 protein (P2Y12) inhibitors among older adults, dedicated studies on the duration of DAPT for older adults undergoing PCI remain limited. [6][7][8] Therefore, we aimed to examine the association of abbreviated DAPT with adverse clinical events, major adverse cardiovascular events, and bleeding among older adults by performing a systematic review and network meta-analysis of randomized clinical trials (RCTs).…”

“…However, a uniform approach to DAPT duration after a PCI across the age spectrum may be suboptimal. Older adults have been variably defined as 65 years of age or older to 75 years of age or older depending on the literature source, have more complex coronary anatomy, and are at the highest risk for future cardiovascular events, while simultaneously having the highest risk for bleeding complications . Despite the distinct anatomical and clinical risk factors and their potential implications for adverse outcomes associated with purinergic receptor P2Y, G-protein–coupled, 12 protein (P2Y12) inhibitors among older adults, dedicated studies on the duration of DAPT for older adults undergoing PCI remain limited .…”

Current ideas about the role of ranolazine in patients’ treatment with angina pectoris

“…Очевидно, что в таких условиях роль противоишемической терапии, в том числе и препаратов с механизмом действия, альтернативным β-блокаторам, антагонистам кальция (АК) и длительно действующим нитратам, становится особенно важной в лечении пациентов с хроническим течением ИБС и стенокардией. Кроме того, учитывается большое число пациентов с хроническим течением ИБС среди лиц пожилого и старческого возраста, которые нередко имеют сопутствующие заболевания и характеристики, ограничиваю щие применение противоишемических средств, снижаю щих частоту сердечных сокращений (ЧСС) и (или) уровень артериального давления (АД) [5].…”

Long-term clinical outcomes in elderly patients with chronic total occlusion and type 2 diabetes: the impact of coronary collateralization following successful recanalization

“…While some studies have addressed the impact of CC in relation to T2DM on clinical prognosis [12] , elderly patients are consistently underrepresented in clinical trials and studies. Current recommendations for older individuals are largely extrapolated from cardiovascular guidelines [13] . Guo et al [14] provided comprehensive evidence on percutaneous coronary intervention (PCI) comparing younger patients with elderly patients with CTO.…”