Cardiovascular disease in the elderly

September has come to represent a truly special time at Cardiology Review, the month in which we publish our annual issue devoted to cardiovascular disease in the elderly. This year we present three continuing medical education (CME) articles (with accompanying commentaries) that revisit two subjects always of interest

to our readers (hypertension and polypharmacy) and introduce one subject that has received enormous attention of late (erectile dysfunction).

Treatment options for hypertension in the elderly are a continuing concern for physicians for a variety of reasons, not the least of which is the increasing number of people with high blood pressure living until their seventies, eighties, and even nineties. Drs. Harun Otieno and Alan H. Gradman have provided a comprehensive overview of not only the treatment issues but also the epidemiology and pathology of hypertension in the elderly. As Dr. Pantel S. Vokonas notes in his commentary, isolated systolic hypertension has emerged as a dominant risk factor for adverse cardiovascular outcomes in this age group.

Unfortunately, the use of a variety of drugs (which is often what hypertensive patients require, as per JNC 7 guidelines) can also lead to abuse. Hence, the importance of our second article: managing polypharmacy issues in the elderly. Patients in this age group have to be especially careful about drugs that have troubling side effects, drugs that may interact with one another, and drugs that have inherent compliance problems, eg, those requiring multiple doses per day. Drs. C. Wayne Weart and Nannette M. Berensen update their previous contribution to this debate in a new and highly informative presentation. Along with the pertinent commentary by Dr. Stephen P. Glasser, I think our readers will find the polypharmacy discussion very helpful.

Our third topic, erectile dysfunction, is a new one for our readers. Always a problem with diabetic patients, physicians now encounter it in other patients as well, especially elderly ones. Its relation to cardiovascular disease (especially endothelial dysfunction) and pharmacologic therapy is reviewed by Dr. Robert A. Kloner, an expert in the field and one of the leading researchers of therapy with PDE-5 inhibitors. The commentary provided by Dr. Melvin D. Cheitlin emphasizes what can be done about this problem and points out the risks associated with drug therapy in coronary patients.

In a bonus feature in the stroke section, Drs. Joachim Schofer and Thilo Tübler from Germany assess the problem of focal cerebral ischemia after neuroprotected carotid artery stenting. Of the 42 patients studied, about 25% had predominantly silent cerebral ischemia despite the neuroprotection. The safety concerns of the authors are echoed by Dr. John J. Ricotta, our vascular surgery consultant, in his commentary.