Heart failure in the elderly.

The aging of the population is, currently, a major phenomenon, drawing the attention of a number of investigators. The significant increase of life expectancies over the past few decades, in addition to social and economic consequences, has lead to a major change in the morbidity and mortality profile of elders. Heart failure (HF) is a condition in which the heart can not pump enough blood to meet the body's needs. HF is predominantly a disorder of the elderly with rates increasing exponentially. The prevalence of HF approximately doubles with each decade of life. As people live longer, the occurrence of HF rises, as well as other conditions that complicate its treatment. Impaired heart function implies a reduced duration of survival. Fortunately, many factors that can prevent HF and improve outcome are known and can be applied at any stage. This review emphasizes the importance of factors inherent in aging itself, focusing on heart disease, particularly as a disease of aging, can help critically refine management of this acute and chronic disease, as well as foster preventive strategies to reduce the incidence of this common malady.

Importance of high-density lipoprotein-cholesterol (HDL-C) levels to the incidence of cardiovascular disease (CVD) in the elderly.

Studies about the impact of HDL-C levels on the incidence of cardiovascular disease (CVD) in the elderly are scarce. We decided to evaluate the relation of clinical and laboratory variables to the incidence of CVD events in the elderly stratified according to HDL-C behavior in an 8-year follow-up. We assessed 126 elderly (mean age: 70.01±7.24 years; 33.3% were men) on two occasions (assessment 1=A1, and assessment 2=A2), with a minimum of 5-year interval. They underwent clinical and laboratory evaluation and were divided into three groups as follows: (1) GN (n=52), normal HDL-C levels on A1 and A2; (2) GL (n=36), low HDL-C levels on A1 and A2; (3) GV (n=38), HDL-C levels varying from A1 to A2. The following CVD events were observed: coronary artery disease (angina pectoris=AP, myocardial infarction=MI, percutaneous/surgical coronary intervention); stroke; transient ischemic attack=TIA; carotid disease; and heart failure=HF. The groups did not differ in age or gender at A1 and A2. Triglyceride=TG mean levels were lower in GN at A1 (p=0.007) and A2 (p<0.001) than in GL. There were 14 CVD events in GN (26.9%), 23 (63.9%) in GL, and 13 (34.2%) in GV (χ2=12.825; p=0.002). In logistic regression analysis, we observed that the higher the systolic blood pressure (SBP) (odds ratio [OR]=1.0231; p=0.0338) and the lower the HDL-C (OR=0.9363; p=0.0035), the higher the incidence of CVD events. Persistently low HDL-C levels over 8 years of follow-up were a risk factor (RF) for the development of CVD events in the elderly.

Study of the intima-media thickening in carotid arteries of healthy elderly with high blood pressure and elderly with high blood pressure and dyslipidemia.

OBJECTIVE: The objective of this study was to assess the mean intima-media thickening of carotid arteries of elderly subjects, and its relationship with age, anthropometric measurements, high systolic blood pressure and dyslipidemia. METHODS: In this investigation, 129 subjects were enrolled between 1995 and 1998, age ranging from 29 to 94 years. They were assigned to one of 4 groups, including 2 control groups (group I, of healthy younger subjects; group II of healthy elderly subjects). Groups III and IV included those who presented with isolated systolic hypertension (ISH), and ISH and dyslipidemia, respectively. All subjects were submitted to a medical interview, lab tests with measurement of cholesterol levels, electrocardiogram, and carotid ultrasound. The ultrasound included measurement of the intima-media thickening (IMT) of the carotid arteries, the right carotid artery (RCA) and left carotid artery (LCA), and assessment of the presence of plaques. Blood fat and glucose were measured by a standard method. The results were compared among the groups through statistical tests. The tests employed were: Chi-Square, Pearson's and Likelihood Ratio, Student's t, Mann-Whitney; ANOVA followed by Tukey's test, Kruskal-Wallis nonparametric test, and test for multiple comparisons and Odds Ratio determination (OR). RESULTS: In this investigation, a positive association was observed between aging and IMT. In relation to systolic hypertension, a significant association was observed with IMT (IMT-RCA p = 0.0034; IMT-LCAp = 0.0196; IMT-RLCAp = 0.0299), and with the presence of plaques (PlaqueR p = 0.0110; PlaqueL p = 0.0294; PlaqueRL p = 0.0040). CONCLUSION: This investigation evidenced the important role of aging in IMT, and of systolic hypertension in the IMT and presence of plaque. However, further studies are needed for a better understanding of the actual role of risk factors in aging.