Cardiovascular Diseases Among

The Elderly
 Introduction
Cardiovascular diseases (CVDs) are a group of disorders of the heart
and blood vessels and they include:
• coronary heart disease – disease of the blood vessels supplying
the heart muscle;
• cerebrovascular disease – disease of the blood vessels supplying
the brain;
• peripheral arterial disease – disease of blood vessels supplying
the arms and legs;
• rheumatic heart disease – damage to the heart muscle and heart
valves from rheumatic fever, caused by streptococcal bacteria;
• congenital heart disease – malformations of heart structure
existing at birth
• deep vein thrombosis and pulmonary embolism – blood clots in
the leg veins, which can dislodge and move to the heart and
lungs.
 Introduction
• CVD prevalence rises with age.
• The statistics published by AHA on prevalence of
CVD (they include coronary heart disease, heart
failure, stroke, and hypertension) states that 73.3%
in men and 72.6% in women aged 60 to 79 years
have episodes of CVD.
• By age 80, these percentages rise to 79.3% and
85.9%, respectively.
• Heart failure, the end stage of CVD, is the number
one cause of hospitalisation and rehospitalisation in
older adults and its incidence increases following
age 65.
 Introduction
• Heart attacks and strokes are usually acute events
and are mainly caused by a blockage that prevents
blood from flowing to the heart or brain.
• The most common reason for this is a build-up of
fatty deposits on the inner walls of the blood
vessels that supply the heart or brain.
• Strokes can also be caused by bleeding from a
blood vessel in the brain or from blood clots.
• The cause of heart attacks and strokes are usually
the presence of a combination of risk factors, such
as tobacco use, unhealthy diet and obesity, physical
inactivity and harmful use of alcohol, hypertension,
diabetes and hyperlipidaemia.
 Introduction
• Heart failure- a progressive disorder of the heart
in which the heart is unable to pump sufficient
blood for the body’s metabolic demands. It results
from such disorders as hypertension, rheumatic
heart disease, coronary artery disease, and valve
insufficiency.
• Atherosclerosis- deposition of fatty plaques within
artery walls. Medium and large arteries acquire
yellowish deposits composed of cholesterol, fat,
cellular debris, and calcium. These plaques cause
vessel walls to become thick and hardened.
 Nutrition Epidemiology
• Calorie intake is increasing among the population in
terms of saturated fats, trans fats from processed
foods and cholesterol from animal foods.
• On the other hand intake of dietary fibre is much
lower to the recommended 20-35 g/day.
• The recommended intake of five serves per day of
fruits and vegetables is also not met.
• There is a need for more education about nutrition
and cardiovascular health.
• Smoking, excess alcohol and physical inactivity are
prominent contributing lifestyle practices.
 Risk factors
• Risk factors in old age remain the same as in younger
adults except that the factors have less predictive value in
old age.
• They include increasing age, male gender, heredity,
smoking, dyslpidemia, high BP, physical inactivity, obesity
and overweight, and diabetes.
• Diabetes and hypertension are the most important risk
factors.
• There are also a number of underlying determinants of
CVDs or "the causes of the causes". These are a reflection
of the major forces driving social, economic and cultural
change – globalization, urbanization and population
ageing. Other determinants of CVDs include poverty, stress
and hereditary factors.
Hypertension
 Hypertension
• In adults older than 50 years of age, 90% have a
lifetime risk of having hypertension.
• It is the only chronic condition that has higher
prevalence in older adults than arthritis.
• It is a major risk factor for stroke (a condition
involving reduced cerebral blood flow, and is a
marker for increased risk of disability and
death), coronary artery disease, heart attack,
and heart failure.
 Hypertension
• Defined as ‘untreated systolic pressure of 140
mmHg or higher, or diastolic blood pressure of 90
mmHg or higher or taking antihypertensive drugs’.
• Diastolic hypertension occurs most often in
middle-aged and older adults. It measure the force
in the blood vessels when the heart is at rest
(between heart beats).
• Systolic hypertension is most common in older
adults. This pressure is a measure of the force
applied against inner walls of the arteries as the
heart pumps blood around the body.
 Hypertension

• Uncontrolled hypertension is a major public health

challenge; prevalence is high and consequences
are serious, and HBP is manageable.
• 70% who have it are aware they have it, yet only
34% of individuals with hypertension have it under
control.
• Prolonged HBP puts extra tension on blood vessels
and organs in the body, wearing them out before
the natural aging process. Damaged kidneys are a
common sign of uncontrolled hypertension.
 Hypertension
• Nutritional risk factors are drinking alcohol to
excess, high-saturated-fat diets leading to
dylipidemia, lifestyles resulting in obesity, and a diet
low in calcium.
• Nutritional strategies to normalize blood pressure
include weight management, moderate alcohol
intake, and limiting sodium intake while maintaining
adequate K, Mg, and Ca intakes.
• The Dietary Approaches to Stop Hypertension
(DASH) diet is effective in decreasing BP and risk of
stroke among elderly.
 Hypertension
• The healthy DASH diet plan was developed to lower blood
pressure without medication in research sponsored by the
US National Institutes of Health. The first DASH diet
research showed that it could lower blood pressure as well
as the first line blood pressure medications, even with a
sodium intake of 3300 mg/day.
• This plan is a diet rich in fruits, vegetables, low fat or nonfat
dairy. It also includes mostly whole grains; lean meats, fish
and poultry; nuts and beans. It is high in fiber and low to
moderate in fat. It is a plan that follows US guidelines for
sodium content, along with vitamins and minerals. In
addition to lowering blood pressure, the DASH eating plan
lowers cholesterol and makes it easy to lose weight. It is a
healthy way of eating, designed to be flexible enough to
meet the lifestyle and food preferences of most people.
 Hypertension
• The DASH diet helps to lower blood pressure by providing
more key nutrients, such as potassium, calcium, and
magnesium, all of which are associated with lower blood
pressure. These key nutrients are boosted by including
more fruits, vegetables, and low-fat or non fat dairy in
your daily diet. Some people see additional benefits by
lowering sodium or salt in their diet. Additional lifestyle
changes to lower blood pressure, such as weight loss,
exercise, smoking cessation, and moderation of alcohol
intake.
• There are two versions
− Standard DASH diet. You can consume up to 2,300
milligrams (mg) of sodium a day.
− Lower sodium DASH diet. You can consume up to 1,500
mg of sodium a day.
The DASH diet
The DASH diet
Dyslipidemia
 Dyslipidemia
• An important step in reducing the risk of
coronary artery disease is to reduce cholesterol
levels.
• Dyslipidemias, (high blood cholesterol, high
triglycerides, high LDLc, and low HDLc), leads to
deposition of plaques of fat and calcium, which
narrow the lining (intima) of arteries and
disturb blood flow, thus increasing the risk of
myocardial infraction and stroke. (refer the
criteria for dyslipidemia from metabolic
syndrome slide)
 Dyslipidemia

• A cholesterol-lowering diet is the initial

therapy for dyslipidemia if the older adult is
not at risk for malnutrition.
• A cholesterol levels under 160 is considered
low and is a marker of malnutrition, an
indication for increased mortality.
• The cholesterol-lowering diet should be
adequate nutritionally, with sufficient calories,
protein, calcium, iron, and vitamins.
 Dyslipidemia

• Note: Discuss various lipoprotein fractions

such as LDL-C, HDL-C and triglycerides here.
• The healthy fats (MUFA, PUFA, Omega-3) and
unhealthy fats (SFA, Trans fats, Dietary
cholesterol) and their food sources here as a
management strategy.
 Other Cardiovascular Diseases
Arrhythmias
•Many types or irregular heartbeats are common
and harmless. But atrial fibrillation (AF) may
occur when heart doesn’t receive enough blood,
which effects the heart’s ability to conduct
impulses properly.
•AF is found by checking the pulse, which will be
irregularly irregular and may go as high as 130-
180 per minute. Immediate treatment is required
as the patient may go into heart failure.
 Other Cardiovascular Diseases

• Management includes warfarin therapy which

keeps the blood thinned. However it interacts
adversely with many medications and some
foods like cauliflower, broccoli, and dark green
leafy vegetables with high vitamin K
antagonize the effects of warfarin.
• Other therapies for AF include cardioversion,
heparin, aspirin for anticoagulation, beta
blockers for slowing the heart rate.
 Peripheral Arterial Disease (PAD)
• Atherosclerosis is the evolving damage to arterial walls
from plaques deposited in walls’ lining. The damage
occurs in the arteries of legs, heart, kidneys, and other
areas. It is a part and parcel of dyslipidemias and
hypertension and can also result from exposure to lead
and cadmium, which come from cigarette smoke.
• It can result in lower extremity arterial disease, or LEAD.
Symptoms include pain and muscle fatigue of lower
extremities with exercise.
• As the disease progresses, the older adult may have pain
even at rest. This is caused by ischemia, extreme
narrowing of the arteries, and in some cases the affected
limb may be lost.
• Older adults with renal insufficiency have shown to have
higher prevalence of PAD.
 Peripheral Arterial Disease (PAD)
• Signs of thin skin at the periphery; loss of hair; cold
extremities; and ulcers that do not heal. Peripheral pulses
may be absent. Skin may be red, toenails thickened, and
the older adult may experience pain and cramping at
night when resting with the feet elevated.
• The risk factors and management for PAD are the same as
those in coronary artery disease. High lipid levels speed
the process of atherosclerosis; smoking causes spasm of
the blood vessels and aggregation of the platelets; both
worsen the disease.
• Drugs are available; some prevent blood clots from
forming or relax and widen the blood vessels. Non-
healing ulcers and gangrene if present, angioplasty or
bypass surgery is considered.
 Myocardial Infraction (MI)
• Death of muscle tissue in heart due to loss of blood
flow from either a blood clot or progressive
narrowing of the coronary arteries. More recently
known as acute coronary syndrome.
• The patient feels nausea; extreme sweating
(diaphoresis); crushing chest pain, which may
radiate to the arms and neck; weakness; and
possible loss of consciousness.
• Risk factors include- increasing age, male gender,
elevated LDL-c, low HDL-c, elevated BP, smoking,
diabetes, family history of CVD, obesity and
sedentary lifestyle.
 Myocardial Infraction (MI)
• Data says that approx 25% of people who have MI,
will die from it. Half of these will die within one-half
hour from the onset of symptoms.
• The symptoms are different in older adults
compared to younger adults. Fewer than 50%
experience chest pain. Approx 21% are ‘silent’ MIs,
as it is caused by sudden rupture or erosion of an
atheromatous plaque in the blood vessel lining.
• Management includes urgent care, both medical and
surgical. Coronary artery bypass and stent
placement in occluded coronary arteries are
common. Later management includes dealing with
risk factors- hypertension, hyperlipidemias, diabetes
and smoking.
 Heart Failure (HF)
• HF is the end stage cardiac disease. It is
consequence of hypertension, CHD, diabetes
mellitus, and/or cardiomyopathy. It is when the
heart is unable to deliver a sufficient blood supply
to meet body’s need.
• Women tend to develop HF at older age than men.
Women also survive long than men with HF.
• White men and women have higher rate of HF than
do African American men & women. Nearly 30-40%
of those with HF die suddenly due to arrhythmias
associated with HF.
 Heart Failure (HF)
• Risk factors include- High BP, coronary artery
disease, past history of MI, irregular heart
rhythm, diabetes, sleep apnea, viral infection
which damages heart muscle, alcohol abuse
which weaken heart muscles, kidney disease.
• Cause can be systolic (abnormal pumping
function of the heart) or diastolic ( heart’s
inability to relax so that it can fill with blood)
dysfunction. Diabetic women with elevated
BMIs or low creatinine clearance are at highest
risk for HF.
 Heart Failure (HF)
• Important management tool for older adults with
HF is weekly weight check. Older adults should be
weighed daily and a weight gain of 2 pounds (1.2
kgs) or more should be reported.
• Fluid volume over load is a major problem in HF,
because the fluid accumulation in the periphery and
in the lungs.
• Sodium management is very important. Older
adults with HF should be on no-added-salt diet and
possibly even more stringent salt restriction, such as
consuming no more than 1.5-2 g/day. Mg and K rich
foods like roasted almonds, whole grain cereals,
spinach, avocados, raisins, banana should be
included in diet.