[Coronary artery disease in patient 80 years and older].
The prevalence of coronary artery disease increases with age. Its clinical presentation is even less typical and its prognosis even more severe that it occurs in frail subjects with several co-morbidities. These atypical symptoms are often associated with a delayed diagnosis and therapy. The presence of comorbidities requires a comprehensive geriatric assessment to detect the existence of "frailty". Evidence based medicine available for coronary artery disease is based on studies that involve very few subjects over 80 years and recommendations are extrapolated from data based on evidence obtained in younger populations. Basically the strategy of treatments of coronary artery disease in octogenarians remains identical to the youngest subject. However, epidemiological studies indicate an under-prescription of recommended drugs whereas this older population is likely to derive the greatest benefit because of its elevated cardiovascular risk. Cautions for use of cardio-vascular therapies are necessary in octogenarian people because of comorbidities and pharmacokinetic and pharmacodynamic changes related to aging. Globally, the therapeutic strategy of coronary artery disease should be based not on the age but on an individual analysis that takes into account the severity of coronary artery disease, the existence of comorbidities, the iatrogenic risk, the expectancy and the quality of life of the patient.
Hanon
Olivier
O
Département de gériatrie, hôpital Broca, université de Paris-Descartes 5, 75013 Paris, France. olivier.hanon@brc.aphp.fr
D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D009204:Myocardial Revascularization
D002317:Cardiovascular Agents
Maladie des artères coronaires après 80 ans.