Elderly patient with coronary artery disease. What are common problems that need solving?
https://doi.org/10.33667/2078-5631-2021-11-8-11
Abstract
The health profile of elderly patients with coronary artery disease commonly includes comorbidities, polypharmacy, a high likelihood of side effects in drug interactions, depression, cognitive deficit, which inevitably affects the quality and effectiveness of drug therapy as well as adherence to the prescribed therapy. The risk of poor outcomes is less likely to be adequately assessed in elderly patients with coronary artery disease. They less often receive effective drug therapy to manage the risks. This article discusses the optimal selection of highly effective antianginal medical therapy aimed at preventing recurrent episodes of angina pectoris and improving the quality of life of an elderly patient with coronary artery disease.
Keywords
coronary artery disease,
angina pectoris,
elderly,
comorbidities,
antianginal therapy,
trimetazidine
Supporting agencies: The publication was prepared in cooperation with the world‑class Scientific and Educational Centre "Kuzbass".
About the Authors
O. L. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
Russian Federation
Russian Federation
Barbarash Olga L.
Kemerovo
V. V. Kashtalap
Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
Russian Federation
Russian Federation
Kashtalap Vasily V.
Kemerovo
K. E. Krivoshapova
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Russian Federation
Krivoshapova Kristina E.
Kemerovo
References
1. Wan H., Goodkind D., Kowal P. International Population Reports: An Aging World: 2015. DC: U.S. Government Publishing Office; 2016: 165. DOI: 10.13140/RG.2.1.1088.9362.
2. Federal State Statistics Service Russian Federation. Available at: http://www.gks.ru/wps/wcm/connect/rosstat_main/rosstat/en/main/ (accessed: 07.07.2019).
3. Hamczyk M., Nevado R., Barettinо A., Fuster V. Biological versus chronological aging. JACC. 2020; 75: 919–30. DOI: 10.1016/j.jacc.2019.11.062.
4. Roth Gt., Mensah G., Johnson C. et al. Global Burden of cardiovascular diseases and risk factors, 1990–2019. JACC. 2020; 76: 2982–3021. DOI: 10.1016/j.jacc.2020.11.010.
5. Barnett K., Mercer S.W., Norbury M. et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380 (9836): 37–43. DOI: 10.1016/S0140–6736(12)60240–2.
6. Гайфулин Р.А., Сумин А.Н., Иванов С.В., Барбараш Л.С. Выживаемость после хирургического лечения больных с мультифокальным атеросклерозом в различных возрастных группах. Комплексные проблемы сердечно-сосудистых заболеваний. 2017; 2: 6–18. Gaifulin R.A., Sumin A.N., Ivanov S.V., Barbarash L.S. Survival after surgical treatment of multifocal atherosclerosis in different age groups. Complex Issues of Cardiovascular Diseases. 2017; 2: 6–18. (In Russ.). DOI: 10.17802/2306–1278–2017–2–6–18.
7. Searle S.D., Mitnitski A., Gahbauer E.A. et al. A standard procedure for creating a frailty index. BMC Geriatrics. 2008; 8 (1): 24. DOI:10.1186/1471–2318–8–24.
8. Ткачева О.Н., Котовская Ю.В., Рунихина Н.К. и др. Клинические рекомендации «Старческая астения». Российский журнал гериатрической медицины. 2020; 1: 11–46. Tkacheva O.N., Kotovskaya Y.V., Runikhina N.K. et al. Clinical guidelines on frailty. Russian Journal of Geriatric Medicine. 2020; 1: 11–46. (In Russ.) DOI: 10.37586/2686–8636–1–2020–11–46.
9. Cesari M., Leeuwenburgh C., Lauretani F. et al. Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study. Am J Clin Nutr. 2006; 83: 1142–48. DOI: 10.1093/ajcn/83.5.1142.
10. Mohr B.A., Bhasin S., Kupelian V. et al. Testosterone, sex hormone-binding globulin, and frailty in older men. J Am Geriatr Soc. 2007; 55: 548–55. DOI: 10.1111/j.1532–5415.2007.01121.x.
11. Кривошапова К.Е., Вегнер Е.А., Терентьева Н.А. и др. Синдром старческой астении у пациентов с ишемической болезнью сердца. Медицинский алфавит. 2020; (19): 6–10. Krivoshapova K.E., Vegner E.A., Terentyeva N.A. et al. Frailty syndrome in patients with coronary artery disease. Medical Alphabet. 2020; (19): 6–10. (In Russ.) DOI: 10.33667/2078–5631–2020–19–6–10.
12. Стабильная ишемическая болезнь сердца. Клинические рекомендации – 2020. Российский кардиологический журнал. 2020; 25 (11): 4076. Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2020; 25 (11): 4076. (In Russ.) DOI: 10.15829/1560–4071–2020–4076.
13. Белялов Ф.И. Особенности диагностики и лечения ишемической болезни сердца у пациентов пожилого и старческого возраста. Российский кардиологический журнал. 2017; 3: 72–6. Belyalov F.I. The specifics of ischemic heart disease management in elderly. Russian Journal of Cardiology. 2017; 3: 72–6. (In Russ.) DOI: 10.15829/1560–4071–2017–3–72–76.
14. Daniel E. Forman, James A. de Lemos, Leslee J. Shaw et al. Cardiovascular biomarkers and imaging in older adults. JACC council perspectives. JACC. 2020; 7 (13): 1577–94. DOI: 10.1016/j.jacc.2020.07.055.
15. Zeng W., Stason W.B., Fournier S. et al. Benefits and costs of intensive lifestyle modification programs for symptomatic coronary disease in Medicare beneficiaries. American Heart Journal. 2013; 165 (5): 785–92. DOI: 10.1016/j.ahj.2013.01.018.
16. Patel A.V., Bernstein L., Deka A. et al. Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am.J. Epidemiol. 2010; 172: 419–29. DOI: 10.1093/aje/kwq155.
17. Gellert C., Schüttker B., Brenner H. Smoking and all-cause mortality in older people: systematic review and meta-analysis. Arch. Intern. Med. 2012; 172: 837–44. DOI: 10.1001/archinternmed.2012.1397.
18. Knuuti J., Wijns W., Saraste A. et al. Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41 (3): 407–77. DOI: 10.1093/eurheartj/ehz425.
19. Cave A.C., Ingwall J.S., Friedrich J. et al. ATP synthesis during low-flow ischemia: influence of increased glycolytic substrate. Circulation. 2000; 101 (17): 2090–6. DOI: 10.1161/01.cir.101.17.2090.
20. Wolff A.A., Rotmensch H.H., Stanley W.C., Ferrari R. Metabolic approaches to the treatment of ischemic heart disease: the clinicians’ perspective. Heart Fail Rev. 2002; 7 (2): 187–203. DOI: 10.1023/a:1015384710373.
21. Kantor P.F., Lucien A., Kozak R., Lopaschuk G.D. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial longchain 3-ketoacyl coenzyme A thiolase. Circ Res. 2000; 86 (5): 580–8. DOI: 10.1161/01.res.86.5.580.
22. El Banani H., Bernard M., Baetz D. et al. Changes in intracellular sodium and pH during ischaemia-reperfusion are attenuated by trimetazidine. Comparison between low- and zero-flow ischaemia. Cardiovasc Res. 2000; 47 (4): 688–96. DOI: 10.1016/s0008–6363(00)00136-x.
23. Marzilli M., Klein W.W. Efficacy and tolerability of trimetazidine in stable angina: a meta-analysis of randomized, double-blind, controlled trials. Coron Artery Dis. 2003; 14 (2): 171–9. DOI: 10.1097/00019501–200304000–00010.
24. Peng S., Zhao M., Wan J. et al. The efficacy of trimetazidine on stable angina pectoris: a meta-analysis of randomized clinical trials. Int J Cardiol. 2014; 177 (3): 780–5. DOI: 10.1016/j.ijcard.2014.10.149.
25. Szwed H., Sadowski Z., Elikowski W. et al. Combination treatment in stable effort angina using trimetazidine and metoprolol: results of a randomized, double-blind, multicentre study (TRIMPOL II). TRIMetazidine in POLand. Eur Heart J. 2001; 22 (24): 2267–74. DOI: 10.1053/euhj.2001.2896.
26. Sellier P., Audouin P., Payen B. et al. Acute effects of trimetazidine evaluated by exercise testing. Eur J Clin Pharmacol. 1987; 33 (2): 205–7. DOI: 10.1007/BF00544569.
27. Марцевич С.Ю., Кутишенко Н.П., Гинзбург М.Л. и др. Исследование КАРДИОКАНОН: способ решения вопроса о клинической эквивалентности оригинальных и воспроизведенных препаратов. РФК. 2012; 8 (2): 179–84. Martsevich S. Yu., Kutishenko N.P., Ginzburg M.L. et al. The KARDIOKANON study: a way to settle the subject of clinical equivalence of generic and original drugs. Rational Pharmacother. Card. 2012; 8 (2): 179–84. (in Russ.)
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For citations:
Barbarash O.L., Kashtalap V.V., Krivoshapova K.E. Elderly patient with coronary artery disease. What are common problems that need solving? Medical alphabet. 2021;1(11):8-11. (In Russ.) https://doi.org/10.33667/2078-5631-2021-11-8-11
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