Cardiovascular Disease and the Older Adult

I am writing this article a day after attending a meeting of the soon-to-be PGY3’s in core internal medicine at the University of Toronto. The meeting was an information session on how to apply for subspecialty training in internal medicine. Part of the session showed the number of residents who entered various training programs in previous years. The number of trainees entering cardiology was staggering in comparison to those entering geriatrics. After my initial intense burst of jealousy, I had to acknowledge a few truths: cardiology is more popular than geriatrics, older patients have a high burden of CVS disease and need cardiologists, and most cardiologists see large numbers of older adults. Cardiovascular disease remains the most important cause of mortality among older adults, and even for those of us with a particular interest in dementia it is vital to recognize the important role of vascular disease in cognitive impairment. For these reasons (and many more), we offer a theme issue on cardiovascular disease each year. I would recommend the brilliant article in the April 2004 American Journal of Medicine by David Alter and David Naylor showing that modern cardiovascular interventions, if anything, benefit older people more than younger adults.

One of the most common problems we see in older adults is hypertension, and substantial data prove that blood pressure control is quite beneficial to older people. How to control the pressure is the content of the article “Selecting Initial Antihypertensive Therapy for Older Adults” by Dr. Norm Campbell and Dr. Sailesh Mohan. Angina is a common problem in older individuals (and can be quite atypical and difficult to diagnose). “Nonsurgical Management of Chronic Exertional Angina in Older Adults” by Dr. Kenneth Melvin and Lindsay Melvin addresses medical management of angina while Dr. Sameer Satija and Dr. Nanette Wenger review the topic of “Revascularization of Chronic Angina among Older Adults.” Antiplatelet therapy has been a great advance in the treatment of CVS diseases but does carry some risks. The article “Dual Antiplatelet Therapy for Cardiovascular Protection: Indication, Duration, and Other Considerations” by Nastaran Ostad and Dr. Glen Pearson addresses the topic of more intensive antiplatelet therapy.

As well as articles on our focus of CVS disease we have our usual varied group of articles. One of Canada’s most eminent geriatricians and also an expert on dementia, David Hogan, contributed the article “A Practical Approach to the Use of Cholinesterase Inhibitors in Patients Newly Diagnosed with Alzheimer’s Disease.” Usually when we talk about technology in medicine, we are thinking “high tech.” However, the article “Canes and Walkers: A Practical Guide to Prescribing” by Dr. Robert Lam and Alison Wong reminds us that some very low tech interventions can make an enormous difference for our older patients. The eyes are perhaps the “mirror to the soul,” but for older adults the eyes and vision are a vital connection not only to the soul but to the world around them. The article “Current Options in Low Vision Rehabilitation” by Dr. Samuel Markowitz is very important in order to maximize the visual capabilities of those with impairment.

Enjoy this issue,
Barry Goldlist