Risk factors for atherosclerosis in an elderly outpatient population in the city of São Paulo.

OBJECTIVE: To analyze in out clinic elderly patients of both sexes for the prevalence of risk factors for atherosclerosis and study their association with the complications of atherosclerosis. METHODS: Five hundred and sixteen outpatients, 152 men and 364 women, 60 years or older, were studied. The prevalences of hypertension, dyslipidemia, diabetes mellitus, cigarette smoking and obesity were determined in both sexes and compared using the chi-square test. The association between these factors and the presence of atherosclerotic complications was analyzed by logistic regression. RESULTS: The comparative analysis of the factors in both sexes showed that hypertension, total cholesterol > or = 240 mg/dL, LDL-cholesterol > or = 160 mg/dL, and body mass index > 27.5 were more frequent among women, but HDL-cholesterol < 35 mg/dL and cigarette smoking were more frequent among men, and no difference occurred between sexes in relation to the frequency of triglycerides > or = 250 mg/dL and diabetes mellitus. After adjustment of the variables in the regression model, we observed that in the total of elderly patients, risk factors for complications of atherosclerosis were: triglycerides > or = 250 mg/dL, hypertension, and male sex. Among men, the risk factors were: LDL-cholesterol > or = 160 mg/dL, diabetes mellitus, HDL-cholesterol < 35 mg/dL and hypertension. Among women, the risk factors were: triglycerides > or = 250 mg/dL and hypertension. CONCLUSION: The results showed that, in the elderly, the risk factors for atherosclerosis persist, but with different behaviors between men and women. The study suggests that the relative importance of the risk factors can change with the aging process.

Age-related changes in elastic fibers of human heart.

The effects of age on the human heart elastic fibers were studied by light and electron microscopy. Studies were done on 15 hearts from male subjects 42 days to 87 years of age. Using specific staining procedures, the length of elastic fibers was determined by morphometry in the parenchyma of right and left ventricles. These studies suggest that the length of elastic fibers per unit heart volume is present early in life, possibly at birth, and thereafter remains constant until adulthood. Average fiber length increases significantly beyond the third decade of life which can be interpreted as a continuous formation of new fibers and a continuous apposition of elastic-type material to these fibers. Electron microscopy confirmed the presence of mature elastic fibers at birth, since they contained amorphous substance (elastin) surrounded by numerous microfibrils. In the adult hearts, the amount of amorphous substance has increased and the number of microfibrils has decreased. With advancing age the amorphous substance forms areas of rarefaction and the microfibrils have disappeared. Whether or not such morphometric modifications could influence the elastic properties of the ventricular myocardium requires further study.

[Chronic atrial fibrillation in the elderly]. / Fibrilação atrial crônica no idoso.

PURPOSE: To evaluate the different aspects of chronic atrial fibrillation (CAF) in elderly patients. METHODS: Forty nine patients with CAF (18 men) aged 66 to 87 years (76.1 years on average) were studied. Their evaluation consisted of clinical examination, blood tests, electrocardiogram, chest X-Ray and echocardiogram. RESULTS: The frequency of CAF in the out-patient Geriatric Clinic was 4.8% and it rose with aging. Cardiocirculatory diseases were observed in 39 (79.6%) patients: 25 (51.0%) had systemic arterial hypertension, 11 (22.4%) had mitral valve disease and six (11.2%) had aortic valve disease. Thirty patients had diseases of other systems, eight (16.3%) of whom were diabetic and seven (14.3%) had hyperthyroidism. Vascular brain disease was observed in four (8.2%) patients. Electrocardiographic changes other than CAF were observed in 41 (83.7%) patients. Changes in the ST-T segment were the more frequent, being observed in 28 (57.1%) patients, followed by left ventricular hypertrophy in 15 (30.1%). Cardiomegaly was seen in 36 (78.3%) out of 46 patients who did the chest radiography. An echocardiogram was performed in 35 patients, being found normal in seven (20.0%). In the remaining cases, the abnormality more frequently seen was the left atrial enlargement, seen in 16 (45.7%) patients. Four patients didn't show clinical, electrocardiographic, radiological or echocardiographic evidence of cardiocirculatory disease and in these, the thyroid function was normal. Digitalis therapy was used in 37 patients. Of the remaining 12, 10 had normal ventricular frequency without the use of the drug. CONCLUSION: The CAF in the elderly patient is observed not only in patients with cardiocirculatory diseases, but in thyrotoxic patients and sometimes without known etiology.

[Cardiac manifestations of hyperthyroidism in the elderly]. / Manifestações cardíacas do hipertireoidismo no idoso.

PURPOSE: To evaluate the cardiocirculatory abnormalities of hyperthyroidism in the elderly. PATIENTS AND METHODS: Twenty-four hyperthyroid patients, 18 women and six men, aged 60 to 87 (average 73.5) years were studied. Seventeen (70.9%) patients had associated cardiocirculatory diseases. The evaluation was made on clinical grounds complemented by electrocardiographic, radiologic, phonomechanocardiographic and echocardiographic examinations. RESULTS: Cardiocirculatory symptoms were observed in 17 (70.9%) patients and congestive heart failure in nine (37.5%) of them. The electrocardiogram was abnormal in 20 (83.3%) patients and the tachyarrhythmias were the commonest abnormality (62.5%). Eight (33.3%) patients had chronic atrial fibrillation and five (20.8%) had sinus tachycardia. There was no significant statistical difference on the electrocardiograms of patients with and without cardiocirculatory abnormalities. Cardiomegaly was significantly more prevalent in hyperthyroid patients, with (64.7%) or without (57.1%) cardiocirculatory abnormalities, than in normal elderly (23.9%). Left ventricular performance was studied in 14 patients through the systolic quotient and was found normal or high in 12 (85.7%). The percentage of fractional shortening (delta D%) was higher than 30 in all patients. None of the patients was found to have symmetric or asymmetric hypertrophic cardiomyopathy and mitral valve prolapse on echocardiogram. CONCLUSION: Hyperthyroidism in the elderly patient determines frequently cardiocirculatory abnormalities that may be misdiagnosed with those caused by the ageing process or by associated cardiopathies. This diagnosis should be suspected in all elderly patients having tachyarrhythmias and/or cardiac failure resistant to usual therapy, mainly in patients without clear cardiocirculatory pathology.

[Megaloblastic anemia in the elderly]. / Anemia megaloblástica em idosos.

From 1974 to 1984, the authors reviewed the clinical records of 20 elderly patients (10 male) at the Clinics Hospital of the School of Medicine of the University of São Paulo, who were admitted with megaloblastic anemia. Ages varied from 62 to 84 (mean 70.4 years). Clinical conditions was varied and usually severe, major systems affected being the hematologic, cardiocirculatory, neurologic, and digestive. Among hematological findings the most common were anemia with elevated cell volume, high neutrophil segmentation rate, leukopenia, thrombocytopenia and hemolysis. Pathological findings were present in all cases where endoscopy and gastric biopsy were performed. Clinical and hematological conditions were similar in patients with folic acid or vitamin B12 deficiency. 19 patients (90.0%) responded to therapy in an usually prompt and clear manner, however some neurological signs may persist. On the other hand, untreated patients may become seriously ill and even die due to cardiac, hemorrhagic, or infectious complications.