JOIN USAs people live longer, there are the attendant health, social and economic issues to contend with.
There are some common cardiac disorders as well as special cardiac problems, other than the category of accrued health issues, that show up from middle age onwards. Age is an important and strong risk factor for coronary heart disease (CAD).
There are also clustered diseases which have to be tackled simultaneously in order to reduce their impact on the cardiovascular system. Declining function of other organ systems, including the liver and the kidneys, and decreased serum albumin which has an impact on the drugs taken, drug-drug interactions and drug-food interactions, need to be understood.
Equally of relevance is the social fabric of India where parents are dependent on children for social security. Moreover, insurance penetration is inadequate, putting a recurring cost burden on the patient as well as on his or her family.
Aging is an inevitable phenomenon. Some age rapidly, some slowly. Incidence and prevalence of hypertension, coronary artery disease, congestive heart failure, stroke arterial aneurysms and atrial fibrillation increase steeply with advancing age.
As age advances, the heart becomes stiffened and shows signs of thickening. A stiffened ventricle is responsible for diastolic dysfunction that reduces effort tolerance. Over time, systolic performance also decreases.
As age advances, the arteries also become stiff, lose elasticity and become dilated. Arterial stiffness along with altered pulse pressure, as well as pulse reflectivity is responsible for hypertension. The elderly have a special form of hypertension called isolated systolic hypertension. Any value above 140/90 is abnormal. In the aged only systolic pressure is elevated. Hypertension needs to be managed aggressively since uncontrolled hypertension has an impact on the heart, kidney and brain.
Increasing burden of CVD
Around 10-20 per cent of the population have CAD by the fourth decade of life which increases to around 70 per cent by 80 years of age. Coronary disease is extensive and carries high mortality. The symptoms are underappreciated due to reduced exercise tolerance and presentation is often atypical or silent. In chronic CAD, time tested treatment strategies are all useful and well accepted. PTCA as well as CABG are both feasible in selected cases, though at a higher complication rate.
Aortic valve sclerosis is the most common observation, and by itself is an independent predictor of associated CAD. It also progresses and produces aortic stenosis. Aortic stenosis is the most common valvular disease which remains relatively asymptomatic. It is one of the causes of sudden death and heart failure in the elderly, and both established aortic valve replacement as well as emerging transcutaneous aortic valve replacement are possible.
Good dietary habits, regular exercises and avoidance of stress are definitely important, though their impact is less than in someone in his or her twenties.
(The writer is Chief Cardiologist, BGS Global Hospitals.)