Review Article| Volume 25, ISSUE 4, P745-755, November 2009

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Primary and Secondary Prevention of Cardiovascular Disease in Older Adults: A Status Report


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        • American Heart Association
        Heart disease and stroke statistics–2009 update.
        American Heart Association, Dallas (TX)2009
        • U.S. Census Bureau
        US population projections.
        (Available at:) (Accessed April 8, 2009)
        • Lloyd-Jones D.M.
        • Leip E.P.
        • Larson M.G.
        • et al.
        Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age.
        Circulation. 2006; 113: 791-798
        • Chobanian A.V.
        • Bakris G.L.
        • Black H.R.
        • et al.
        The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.
        JAMA. 2003; 289: 2560-2572
      1. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (ATP III).
        JAMA. 2001; 285: 2486-2497
        • Ostchega Y.
        • Dillon C.F.
        • Hughes J.P.
        • et al.
        Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004.
        J Am Geriatr Soc. 2007; 55: 1056-1065
        • Ostchega Y.
        • Toon S.S.
        • Hughes J.
        • et al.
        Hypertension awareness, treatment, and control – continued disparities in adults: United States, 2005–2006.
        (NCHS data brief no) National Center for Health Statistics, Hyattsville (MD)2008
        • Chobanian A.V.
        Isolated systolic hypertension in the elderly.
        N Engl J Med. 2007; 357: 789-796
        • Izzo Jr., J.L.
        • Levy D.
        • Black H.R.
        Clinical advisory statement. Importance of systolic blood pressure in older Americans.
        Hypertension. 2000; 35: 1021-1024
      2. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group.
        JAMA. 1991; 265: 3255-3264
        • Patel A.P.
        • Kostis J.B.
        • Wilson A.C.
        • et al.
        Long-term fatal outcomes in subjects with stroke or transient ischemic attack: fourteen-year follow-up of the Systolic Hypertension in the Elderly Program (SHEP).
        Stroke. 2008; 39: 1084-1089
        • Oates D.J.
        • Berlowitz D.R.
        • Glickman M.E.
        • et al.
        Blood pressure and survival in the oldest old.
        J Am Geriatr Soc. 2007; 55: 383-388
        • Gueyffier F.
        • Bulpitt C.
        • Boissel J.P.
        • et al.
        Antihypertensive drugs in very old people: a subgroup meta-analysis of randomized controlled trials (INDIANA).
        Lancet. 1999; 353: 793-796
        • Beckett N.S.
        • Peters R.
        • Fletcher A.E.
        • et al.
        Treatment of hypertension in patients 80 years of age or older (HYVET).
        N Engl J Med. 2008; 358: 1887-1898
      3. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group.
        JAMA. 2002; 288: 2981-2997
        • Dahlof B.
        • Devereux R.B.
        • Kjeldsen S.E.
        • et al.
        Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.
        Lancet. 2002; 359: 995-1003
        • Jamerson K.
        • Weber M.A.
        • Bakris G.L.
        • et al.
        Benazepril plus amlodipine or hydrocholorthiazide for hypertension in high-risk patients.
        N Engl J Med. 2008; 359: 2417-2428
        • Blood Pressure Lowering Treatment Trialists' Collaboration
        Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomized trials.
        BMJ. 2008; 336: 1121-1123
        • Schober S.E.
        • Carroll M.D.
        • Lacher D.A.
        • et al.
        High serum total cholesterol – an indicator of monitoring cholesterol lowering efforts; U.S. adults, 2005–2006.
        (NCHS data brief no 2) National Center for Health Statistics, Hyattsville (MD)2007
        • Shepherd J.
        • Cobbe S.
        • Ford I.
        • et al.
        Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group (WOSCOPS).
        N Engl J Med. 1995; 333: 1301-1307
        • Sever P.S.
        • Dahlof B.
        • Poulter N.R.
        • et al.
        Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.
        Lancet. 2003; 361: 1149-1158
        • Weverling-Rijnsburger A.W.
        • Blauw G.J.
        • Lagaay A.M.
        • et al.
        Total cholesterol and risk of mortality in the oldest old.
        Lancet. 1997; 350: 1119-1123
        • Scandinavian Simvastatin Survival Study Group
        Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).
        Lancet. 1994; 344: 1383-1389
        • Miettinen T.A.
        • Pyorala K.
        • Olsson A.G.
        • et al.
        Cholesterol-lowering therapy in women and elderly patients with myocardial infarction or angina pectoris: findings from the Scandinavian Simvastatin Survival Study (4S).
        Circulation. 1997; 96: 4211-4218
        • Shepherd J.
        • Blauw G.J.
        • Murphy M.B.
        • et al.
        PROSPER Study Group. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomized trial.
        Lancet. 2002; 360: 1623-1630
        • Ridker P.M.
        • Danielson M.
        • Fonseca F.
        • et al.
        JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.
        N Engl J Med. 2008; 359: 2195-2207
        • Michos E.D.
        • Blumenthal R.S.
        Prevalence of low low-density lipoprotein cholesterol with elevated high sensitivity C-reactive protein in the US.
        J Am Coll Cardiol. 2009; 53: 931-935
        • Heart Protection Study (HPS) Collaborative Group
        MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial.
        Lancet. 2002; 360: 7-22
        • Ray K.K.
        • Bach R.G.
        • Cannon C.P.
        • et al.
        Benefits of achieving the NCEP optional LDL-C goal among elderly patients with ACS.
        Eur Heart J. 2006; 27: 2310-2316
        • Antiplatelet Trialists' Collaboration
        Collaborative overview of randomised trials of antiplatelet therapy–I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients.
        BMJ. 1994; 308: 81-106
      4. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events. CAPRIE Steering Committee.
        Lancet. 1996; 348: 1329-1339
        • Peters R.J.
        • Mehta S.R.
        • Fox K.A.A.
        • et al.
        Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study.
        Circulation. 2003; 108: 1682-1687
        • Yusuf S.
        • Zhao F.
        • Mehta S.R.
        • et al.
        Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.
        N Engl J Med. 2001; 345: 494-502
        • Bhatt D.L.
        • Fox K.A.A.
        • Hacke W.
        • et al.
        Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events.
        N Engl J Med. 2006; 354: 1706-1717
        • Yusuf S.
        • Sleight P.
        • Pogue J.
        • et al.
        Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high risk patients. The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators.
        N Engl J Med. 2000; 342: 145-153
        • Hjalmarson A.
        • Goldstein S.
        • Fagerberg B.
        • et al.
        Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure. The Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF).
        JAMA. 2000; 283: 1295-1302
        • Packer M.
        • Fowler M.B.
        • Roecker E.L.
        • et al.
        Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) study.
        Circulation. 2002; 106: 2194-2199
      5. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. The CAPRICORN Investigators.
        Lancet. 2001; 357: 1385-1390
        • Sparrow D.
        • Dawber T.
        • Colton T.
        The influence of cigarette smoking on prognosis after first myocardial infarction.
        J Chronic Dis. 1978; 31: 415-432
        • Hermanson B.
        • Omenn G.S.
        • Kronmal R.A.
        • et al.
        Beneficial six-year outcome of smoking cessation in older men and women with coronary artery disease: results from the CASS registry.
        N Engl J Med. 1988; 319: 1365-1369
        • Williams M.A.
        • Flegg J.L.
        • Ades P.A.
        • et al.
        Secondary prevention of coronary heart disease in the elderly (with emphasis on patients ≥ 75 years of age).
        Circulation. 2002; 105: 1735-1743
      6. U.S. Department of Health and Human Services. Health People 2010: Understanding and Improving Health. 2nd edition. Washington, DC: US Government Printing Office. November 2000.