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Epidemiology of CVD in the Elderly Karen P. Alexander MD Duke University Medical Center Duke Clinical Research Institute Disclosures: (1) Minor Research:

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Presentation on theme: "Epidemiology of CVD in the Elderly Karen P. Alexander MD Duke University Medical Center Duke Clinical Research Institute Disclosures: (1) Minor Research:"— Presentation transcript:

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) REF: Heart Disease and Stroke Statistics- 2010 Update; Circulation 2010:121;e46-e215 AGE (yrs) POPULATION (%) CVD = CHD, CHF, Stroke

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

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

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

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

7 Older Adults: Disability REF: Griffith L, et al. Age and Ageing 2010;39:738-745 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

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) REF: Arnold AM, et al, JAGS 2005;53:211-218 CHD = Fatal and Non-fatal MI, Angina, coronary revascularization

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 MI Case- Control of Acute MI YoungOld* Smoking3.33 (2.86 - 3.87)2.44 (2.10 – 2.84) HTN2.24 (1.93 – 2.60)1.72 (1.52 – 1.95) Diabetes2.96 (2.40 – 3.64)2.05 (1.71 – 2.45) Abdominal Obesity1.79 ( 1.52 – 2.09)1.50 (1.29 – 1.74) Lipids: ApoB/ApoA14.35 ( 3.49 – 5.42)2.50 (2.05 – 3.05) Fruits and Vegetables0.69 (0.58 – 0.81)0.72 (0.61 – 0.85) Exercise0.95 (0.79 – 1.14)0.79 ( 0.66 – 0.94) Alcohol1.00 (0.85 – 1.17)0.85 (0.73 – 1.00) Psychosocial Stress2.87 ( 2.19 – 3.77)2.43 (1.86 – 3.18) 93.9% 87.9% Population Attributable Risk REF: Yusuf et al, Lancet 2004;364:937-52 * Old = Men >55 yrs; Women >65 yrs

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 CholesterolSmoking REF: Capewell S, Bulletin WHO 2010;88:120-130 HP 2010 * Linear Time Plots based on NHANES 1988- 1994 and NHANES 1999-2002

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

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

17 Estimated Reduction in CHD Deaths by Age Three Risk Factor Scenarios 45-5455-6465-7475-84 Reduction in Deaths from CHD Age Group REF: Capewell S, Bulletin WHO 2010;88:120-130

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

19 Hypertension in the Elderly Framingham Cohort Prevalence of HTN Control of HTN 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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