Coronary artery disease and populational ageing: how to deal with this challenge?

Abstract

Revista HUPE, Rio de Janeiro, 2013;12(Supl 1):13-24

doi:10.12957/rhupe.2013.7079

Ageing is a challenge in contemporary world affecting rich and poor countries. Besides its high prevalence, coronary artery disease in elderly is associated to more atypical presentations, singularities in clinical investigation and a more careful therapeutic approach.In Brazil, cardiovascular diseases are the major causes of death, followed by cancer, external causes and respiratory diseases. The clinical presentations of coronary artery disease may be different and atypical and dyspnea is more common than angina pectoris. Subsequent investigation is similar to younger people but the accuracy of many methods may vary a lot.The differences in the pathophysiology, pharmacokinetics and metabolism of drugs observed in older people must be considered when selecting a therapeutic strategy and its targets. More drugs are necessary to control multiple risk factors and comorbidities, leading to more drug interactions, side effects, less adherence to therapy, higher costs and hospitalizations due to iatrogenic complications. In a way to minimize the side effects due to the association of multiple drugs, prescriptions must be revised in each interview, emphasizing the importance of each drug, adjusting doses and administration routes and aiming to reduce the frequency of administrations. Side effects may exacerbate or suggest other diseases. Clinical decision related to the treatment of coronary artery disease must consider frailty, quality of life and life expectancy, as well as risk and costs. Pharmacological and invasive strategies must be critically selected due to their higher iatrogenic potential observed in the elderly.

Keywords: Coronary disease; Aged; Diagnosis; Therapeutics.