Coronary artery disease in the elderly.
In the past 25 years, the mortality rate due to ischaemic heart disease in the United States of America and many other western countries has decreased significantly, whilst that in Singapore has increased steadily and unrelentlessly. Hypertension is also very common in Singapore, with a prevalence rate of 14% in those who are 20 years and above. Ischaemic heart disease and hypertension both increase dramatically with age and these 2 conditions account for a substantial proportion of the mortality and morbidity in elderly subjects, 65 years and above. Ischaemic heart disease often presents certain special problems with regard to clinical presentation, investigation and treatment in the elderly patients. For example, typical chest pain is much less frequent in elderly patients with angina pectoris or acute myocardial infarction compared to their younger counterparts. Elderly patients are also generally much more sensitive to any form of drug therapy. Therefore anti-anginal drugs such as the nitrates, beta-blockers and calcium antagonists and all types of anti-hypertensive drugs must be administered more carefully, with a smaller starting dosage and with careful monitoring of possible side-effects.
D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy; D003327:Coronary Disease / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control; D009203:Myocardial Infarction / Q000628:therapy; D012306:Risk; D012846:Singapore