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  • Review Article
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Cardiovascular drug therapy in the elderly: benefits and challenges

Nature Reviews Cardiology volume 8, pages 13–28 (2011)Cite this article

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Abstract

Increasing life expectancy in industrialized societies has resulted in a huge population of older adults with cardiovascular disease. Despite advances in device therapy and surgery, the mainstay of treatment for these disorders remains pharmacological. Hypertension affects two-thirds of older adults and remains a potent risk factor for coronary artery disease, chronic heart failure, atrial fibrillation, and stroke in this age group. Numerous trials have demonstrated reduction in these adverse outcomes with antihypertensive drugs. After acute myocardial infarction, β-adrenergic blockers reduce mortality regardless of patient age. Statins and antiplatelet drugs have proven beneficial in both primary and, especially, secondary prevention of coronary events in older adults. In elders with chronic heart failure, loop diuretics must be used cautiously, owing to their higher potential for adverse effects, whereas angiotensin-converting-enzyme inhibitors and β-blockers reduce symptoms and prolong survival. The high risk of stroke in elderly patients with atrial fibrillation is markedly reduced with warfarin, although bleeding risk is increased. The high prevalence of polypharmacy among older adults with cardiovascular disease, coupled with age-associated physiological changes and comorbidities, provides major challenges in adherence and avoidance of drug-related adverse events.

Key Points

  • Aging of the population, coupled with the dramatic age-related increase in cardiovascular disease, has resulted in a huge number of elderly patients requiring chronic medical therapy for these disorders

  • Age-related changes in physiology and body composition result in altered pharmacokinetics and pharmacodynamics that often require drug dosing adjustments in elderly adults

  • Polypharmacy and age-related comorbidities increase the risk of adverse drug– drug and drug–disease interactions among elderly patients

  • Clinical trials have shown that antihypertensive agents, statins, antiplatelet drugs and anticoagulants, β-adrenergic blockers, angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, and aldosterone antagonists benefit elderly patients with cardiovascular disease

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Acknowledgements

The authors gratefully acknowledge the assistance of Nina Hall (Program Analyst; National Heart, Lung, and Blood Institute, Bethesda, MD, USA) and Joanne Pryor (Office Manager for W. H. Frishman; New York Medical College, Valhalla, NY, USA) in preparing this manuscript. The views expressed in this article are those of the authors and do not necessarily reflect those of the NIH, the Department of Health and Human Services, or the US Government. Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Bethesda, 20892, MD, USA

    Jerome L. Fleg

  2. Department of Medicine, New York Medical College, 100 Woods Road, Valhalla, 10595, NY, USA

    Wilbert S. Aronow & William H. Frishman

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J. L. Fleg, W. S. Aronow, and W. H. Frishman researched data for the article, contributed to discussion of content, wrote and reviewed the manuscript before submission, and revised the article after peer-review and editing. The majority of reviewing and revising of the manuscript was done by J. L. Fleg.

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Correspondence to Jerome L. Fleg.

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J. L. Fleg is a stockholder/Director of Bristol-Myers Squibb. The other authors declare no competing interests.

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Fleg, J., Aronow, W. & Frishman, W. Cardiovascular drug therapy in the elderly: benefits and challenges. Nat Rev Cardiol 8, 13–28 (2011). https://doi.org/10.1038/nrcardio.2010.162

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