Elderly Coronary Patients Research Articles

Lower Cardiovascular Stress during Resistance Training Performed with Inter-Repetition Rests in Elderly Coronary Patients.

Background and Objectives: Hemodynamic stress during resistance training is often a reason why this training method is not used in cardiac patients. A lifting protocol that imposes rests between repetitions (IRRT) may provide less hemodynamic stress compared to traditional resistance training (TT). The aim of this study was to verify differences between set configurations on hemodynamic stress responses in resistance training. Materials and Methods: We compared hemodynamic (heart rate (HR), systolic blood pressure (SBP), and rate pressure product (RPP)) responses assessed with the auscultatory method in elderly (age = 75.3 ± 7.3 years) coronary male patients who were participating in a cardiac rehabilitation program allocated to either TT or IRRT with the same load (kg) and total number of repetitions (24) in the bilateral leg extension exercise. Results: IRRT resulted in significant lower values than TT for RPP at repetitions 8 (p = 0.024; G = 0.329; 95% CI: 0.061, 0.598) and 16 (p = 0.014; G = 0.483; 95% CI: 0.112, 0.854). Conclusions: IRRT appears to be a viable method of reducing the hemodynamic response (i.e., RPP) to resistance training and, thus, may contribute to the safety of cardiac rehabilitation programs. Further studies with more cardiac patients and other measurement techniques should be conducted to confirm these important findings.

Application of transcutaneous electric nerve stimulation combined with cognitive behavior intervention in the elderly coronary disease patients with hypertension

Objective To explore the effects of transcutaneous electric nerve stimulation (TENS) combined with cognitive behavior intervention in the elderly coronary disease patients with hypertension. Methods From May 2017 to May 2019, we selected 90 elderly coronary disease patients with hypertension in the Second Affiliated Hospital of Harbin Medical University as subjects by convenience sampling. All of patients were divided into control group and observation group with the method of random number table, 45 cases in each group. Control group carried out cognitive behavior intervention, while observation group implemented the TENS combined with cognitive behavior intervention. We compared the angina pectoris symptom control, blood pressure control and the self-perceived burden with the Self-perceived Burden Scale (SPBS) of patients between two groups. Results After intervention, the effective rate of angina pectoris control of observation group was higher than that of control group with a statistical difference (P<0.05) ; the diastolic pressure and systolic pressure of observation group were lower than those of control group with statistical differences (P<0.05) ; the score of SPBS of patients in control group was higher than that in control group also with a statistical difference (P<0.001) . Conclusions TENS combined with cognitive behavior intervention for elderly coronary disease patients with hypertension contributes to angina pectoris symptom control and reducing the blood pressure as well as self-perceived burden. Key words: Aged; Transcutaneous electric nerve stimulation; Cognitive behavior intervention; Coronary disease; Self-perceived burden

Effects of extended nursing on compliance of clopidogrel in elderly coronary disease with percutaneous coronary intervention

Objective To explore the effects of extended nursing on compliance of clopidogrel in elderly coronary disease with percutaneous coronary intervention (PCI) . Methods From August 2015 to August 2016, we selected a total of 100 elderly patients with coronary disease met the inclusion criteria at Cardiovascular Hospital, He'nan Provincial People's Hospital by convenience sampling. All of the patients were divided into control group and observation group by the random number, 50 cases in each group. Elderly coronary disease patients with PCI of two groups were all treated with clopidogrel. Patients of observation group accepted standardized extended nursing, while patients of control group were treated with conventional intervention. We observed and compared the medicine compliance of patients between observation group and control group. Results Three, six and twelve months post discharge, the scores of regular rehabilitation, taking medicine at a regular time, proper exercise and diet change of patients in observation group after extended nursing were all higher than those in control group with significant differences (t=8.522, 5.020, 5.088, 4.456; P<0.01) ; the proportions of taking medicine on time correctly of patients in observation group were higher than those in control group with significant differences (χ2=5.983, 8.306, 7.865; P<0.05) ; that showed the medicine compliance of observation group was better than that of control group. Conclusions The application of extended nursing in elderly coronary disease patients with clopidogrel after PCI could effectively improve the compliance of clopidogrel. It is worth to be spread in clinic. Key words: Aged; Coronary heart disease; Clopidogrel; Extended nursing; Percutaneous coronary intervention; Medicine compliance

The no-touch saphenous vein graft in elderly coronary bypass patients with multiple comorbidities is a promising conduit to substitute the left internal thoracic artery

ObjectivesWe investigated the patency rates of no-touch saphenous vein grafts anastomosed to the left anterior descending artery compared with the left internal thoracic artery. Further, we compared the patency of no-touch vein grafts to the left anterior descending artery with the patency of no-touch vein grafts to other coronary arteries. MethodsOf 2635 consecutive patients undergoing coronary artery bypass grafting between 2003 and 2008, 168 (6.3%) were given at least a saphenous vein graft to the left anterior descending artery to avoid harvesting complications in high-risk patients or in response to a left internal thoracic artery injury. A total of 97 patients were consecutively included after informed consent. A clinical examination and computed tomography angiography were performed on 91 patients at a mean of 6 (4-9) years. ResultsThe mean age of patients was 75.6 ± 8.5 years. Postoperatively, 88.7% of patients (86/97) were free of angina. The 91 examined patients had 163 grafts with 286 distal anastomoses. Crude patency, according to distal anastomoses, was 94.4% (270/286). The patency of single versus sequential no-touch vein grafts to the left anterior descending artery was 98% (50/51) versus 92.5% (37/40). The total patency rate was 95.6% (87/91), similar to the reported patency rate for the left internal thoracic artery. The no-touch grafts to the left anterior descending artery versus other coronaries had a patency of 95.6% (87/91) versus 93.8% (183/195), a high similarity confirmed by an equivalence analysis. ConclusionsIn elderly coronary bypass patients with multiple comorbidities, a no-touch saphenous vein graft is a promising substitute for the left internal thoracic artery.

The fundamental importance of smoking cessation in those with premature ST-segment elevation acute myocardial infarction.

Smoking is the most prevalent risk factor among young patients suffering acute myocardial infarction (AMI). In this review, we will present data on the detrimental consequences of continued smoking with regard to the recurrence of coronary events after an AMI at an early age. A prospective study with long-term follow-up of young survivors of AMI showed that continuation of smoking after a first episode of AMI was the strongest independent predictor of further cardiac events. In particular, persistent smokers had ∼2.5 times higher risk of a new coronary event when compared with nonsmokers. This emphasizes the fundamental importance of initiating smoking cessation treatment in all smokers with AMI during hospitalization. Extrapolating the results of previous studies showing the benefits of smoking cessation in middle-aged or elderly coronary patients, an even greater benefit should be expected in young patients because of their specific characteristics, which are presented in the current review. Young persistent smokers after a premature AMI constitute a high-risk subgroup for a recurrence of cardiac events. Therefore, smoking cessation is a key issue for improving their prognosis and all smokers should be offered effective antismoking treatment at the time of initial hospitalization.

CYP2C19 LOF alleles confer no risk for HTPR but higher risk for recurrent ischemic events in clopidogrel treated elderly ACS patients

Dual antiplatelet therapy (DAPT), combining aspirin with P2Y12 inhibitor of clopidogrel, has been recommended with compelling evidence for the treatment of acute coronary syndrome (ACS) or the prevention of stent thrombosis in patients who underwent percutaneous coronary intervention (PCI) [ [1] Amsterdam E.A. Wenger N.K. Brindis R.G. et al. 2014 AHA/ACC Guideline for the management of patients with non-ST-Elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2014; 64: e139-e228 Abstract Full Text Full Text PDF PubMed Scopus (1907) Google Scholar ]. As an inactive pro-drug, clopidogrel requires the activation by the hepatic cytochrome P450 (CYP) system to generate its active metabolite, which exerts its antiplatelet effects by irreversibly inhibiting the P2Y12 receptor on platelets. Due to the variability of active metabolite generation, there is marked inter-individual variability (~30%) in the antiplatelet effects of clopidogrel, and a reduced response to this drug may be a risk factor for cardiovascular events [ [2] Mallouk N. Labruyere C. Reny J.L. et al. Prevalence of poor biological response to clopidogrel: a systematic review. Thromb. Haemost. 2012; 107: 494-506 Crossref PubMed Scopus (71) Google Scholar ]. Accumulated pharmacogenetic evidence verified that carriers of CYP2C19 loss-of-function (LOF) alleles have decreased clopidogrel active transformation and diminished platelet inhibition. Genotyping of CYP2C19 may offer a promising clue for a personalized approach of antiplatelet treatments [ [3] Scott S.A. Sangkuhl K. Stein C.M. et al. Clinical Pharmacogenetics Implementation Consortium guidelines for CYP2C19 genotype and clopidogrel therapy: 2013 update. Clin. Pharmacol. Ther. 2013; 94: 317-323 Crossref PubMed Scopus (663) Google Scholar ]. Elderly individuals represent a growing population of patients diagnosed with ACS and treated by PCI. Complex with more comorbidity and concomitant medications, as well as the difficulties for the balance between ischemic and bleeding events, elderly patients should be of priority for personalized antiplatelet therapy [ [4] Silvain J. Cayla G. Hulot J.S. et al. High on-thienopyridine platelet reactivity in elderly coronary patients: the SENIOR-PLATELET study. Eur. Heart J. 2012; 33: 1241-1249 Crossref PubMed Scopus (126) Google Scholar ]. By far, the contribution of CYP2C19 LOF alleles to clopidogrel responsiveness in the elderly, and its implication for personalized antiplatelet treatment in this population remain unknown. In the present study, we aimed to evaluate the effects of CYP2C19 LOF alleles on platelet reactivity and clinical outcomes in elderly ACS patients treated by clopidogrel.

Toward a therapeutic window for antiplatelet therapy in the elderly

This editorial refers to ‘High on-thienopyridine platelet reactivity in elderly coronary patients: the SENIOR-PLATELET study’†, by J. Silvain et al. , on page 1241 Pathophysiological changes reported in the elderly include increased platelet activation and reactivity, elevated levels of coagulation factors and plasminogen activator inhibitor type-1, and decreased bleeding time—all consistent with an increased risk for thrombosis.1 However, elderly patients with coronary artery disease (CAD) also encounter an increased risk of bleeding during antiplatelet therapy. Thus, we face a challenging treatment dilemma in these patients that is further complicated by frequent co-morbid diseases and polypharmacy. Guideline recommendations for antiplatelet therapy in the elderly are fuzzy due to a lack of dedicated pharmacodynamic and clinical outcome studies in this population. Since the first description of clopidogrel response variability and resistance, much has been learned about numerous factors influencing the metabolism of clopidogrel that directly translate into the pharmacodynamic response ( Figure 1 ).2,3 Non-responsiveness to the world's second most widely used antiplatelet agent, now de facto , has fuelled the development of and widespread interest in new and more pharmacodynamically predictable P2Y12 receptor blockers and laid the cornerstone for personalized antiplatelet therapy.3 Figure 1 Various factors influencing platelet reactivity and clinical events during clopidogrel therapy. ADP, adenosine diphosphate; BMI, body mass index; CAD, coronary artery disease; CCB, calcium channel blocker; CYP, cytochrome P450; DDI, drug–drug interaction; HPR, high on-treatment platelet reactivity; LPR, low on-treatment platelet reactivity; PPI, proton pump inhibitor; SJW, St. John's wort; SNP, single …

Alcohol consumption and blood lipids in elderly coronary patients

Alcohol consumption and blood lipids in elderly coronary patients

Alcohol consumption and blood lipids in elderly coronary patients

Alcohol consumption and blood lipids in elderly coronary patients

Alcohol consumption and blood lipids in elderly coronary patients

Alcohol may have a beneficial effect on coronary heart disease (CHD) that could be mediated by elevation of high-density lipoprotein cholesterol (HDLC). Data on alcohol consumption and blood lipids in coronary patients are scarce. We studied whether total ethanol intake and consumption of specific types of beverages are associated with blood lipids in older subjects with CHD. Blood lipids were measured in 1052 myocardial infarction patients aged 60 to 80 years (78% male). Intake of alcoholic beverages, total ethanol, and macronutrients was assessed by food frequency questionnaire. Seventy percent of the subjects used lipid-lowering medication. Total cholesterol was on average 5.14 mmol/L, and HDLC was on average 1.28 mmol/L. Among men, total ethanol intake was positively associated with HDLC (difference of 0.094 mmol/L for ≥15 g/d vs 0 g/d, P = .024), whereas the association with HDLC among women was not significant (difference of 0.060 mmol/L for ≥5 g/d vs 0 g/d, P = .560) after adjustment for dietary, lifestyle, and CHD risk factors. Liquor consumption was weakly positively associated with HDLC in men ( P = .045). Beer consumption in men and wine consumption in women were also positively associated with HDLC, but were not significant in the fully adjusted model. In conclusion, moderate alcohol consumption may elevate HDLC in treated post–myocardial infarction patients. This may be due to ethanol and not to other beneficial substances in alcoholic beverages. Based on this finding, further research needs to be done to examine the effects of the residual substances from different types of alcoholic beverages on HDLC.

Effect of epithalamin on the rhythm of immune and endocrine systems functioning in patients with chronic coronary disease

In contrast to young people, changes in the rhythms of parameters manifested in elderly and senile chronic coronary patients in inversion (decreased T cell count in the peripheral blood, values of lymphocyte blastogenesis test with phytohemagglutinin, and phagocytic index in the fall), monotony (B cell count in the peripheral blood), decreased amplitude of serum hydrocortisone, and desynchronization. The levels of thymic serum factor and IgG were higher in the fall than in the spring, but the seasonal difference leveled after 2.5 years of observation. On the other hand, the rhythms of changes in the thymic serum factor and hydrocortisone were retained in patients with chronic coronary disease after 6 courses of epithalamin by the optimal protocol (period of observation 30 months) and blood T cell count increased in the fall. Improvement of the rhythms of the parameters was associated with a benign clinical course of the disease.

Cardiac Rehabilitation in the Elderly: Patient Selection and Outcomes

In Western countries, the aging and improving survival of patients with coronary heart disease are responsible for an increasing number of older adults (65 years of age and older) who are eligible for cardiac rehabilitation. The elderly with coronary heart disease represent a special population with changes induced by aging and lifestyle, comorbidity, cognitive dysfunction, and high risk of disability. Although the elderly account for the majority of cardiac admissions and procedures, studies on cardiac rehabilitation have traditionally focused on younger patients. In aged experimental animals, there is evidence that exercise training is able to improve hemodynamic parameters and biologic markers. Moreover, in older patients, exercise improves functional capacity and reduces myocardial work, similar to that seen in younger patients. As for younger patients, cardiac rehabilitation requires a multidisciplinary approach, including comprehensive assessment, treatment of risk factors and comorbidity, and psychosocial assessment. Cardiac rehabilitation is safe and helpful for elderly coronary patients. Physicians must be encouraged to prescribe cardiac rehabilitation programs for the elderly following major coronary events and coronary revascularization procedures.

Key factors associated with the under-prescription of statins in elderly coronary heart disease patients: Results from the ELIAGE and ELICOEUR surveys

Introduction The reasons why statins are under-utilized in elderly patients remain poorly understood. The aim of this study was to identify the reasons given by cardiologist for the non-prescription of statins in elderly CHD patients. Methods Two cross-sectional pharmaco-epidemiological surveys were carried out among French cardiologists. The sample consisted of 1148 coronary patients aged 35 to 69 years and 1489 patients aged ≥ 70 years. Patients' risk factors, medical history, treatments, lipid values and the physicians' various motives for the non-prescription of statins were recorded. Results Patients not treated with statins reached 37% in the age-group ≥ 70 years and 14% in the age-group 35–69 years. The main reason given for statin non-prescription was the lack of a medical indication (2.5% of the age-group 35–69 years and 14% of the age-group ≥ 70 years). Among patients ≥ 70 years, the lack of indication was more often cited in the following conditions: 1) in very old patients (36% of lack of indication in the age-group > 85 years vs. 10% in 70–75 years), 2) when lipid values were not available (20% when data were not available vs. 9%) and 3) when the patient had no prior history of myocardial infarction (MI) (20% when no history of MI vs. 7%). These factors were not associated with lack of indication among patients < 70 years. History of intolerance or side effect was given for 1.3% and 14% of patients for each of the groups (35–69 and ≥ 70) and poor overall patient adherence was cited in 1% and 2%, respectively. Conclusion The primary reason for the under-prescription of statins in elderly coronary patients is the perceived lack of indication, which stresses the need of extensive guidelines for prescription in elderly patients. Several factors associated with this perception seem to be specific to the elderly.

Gender Differences in Recovery After Coronary Artery Bypass Graft Surgery

This study examined the effect of gender on symptom evaluation, symptom response, and physical functioning following coronary artery bypass graft surgery. Symptom evaluation and symptom response were measured at baseline and 2, 4, and 6 weeks and 3 months following surgery, and physical functioning was measured at baseline, 6 weeks, and 3 months. The sample included 46 men and 19 women randomly assigned to the routine care group of a larger study examining symptom management intervention influence on recovery outcomes in elderly coronary artery bypass graft patients. No significant differences were found in symptom evaluation, symptom response, or physical functioning by gender over time. Women reported consistently higher symptom evaluation scores for shortness of breath, fatigue, depression, sleep disturbance, swelling, and anxiety and lower mean physical and vitality subscale scores than men at every time point. Gender-specific symptom management strategies should be developed and tested to address the differences in the reporting of symptoms by men and women.

Aortic atherosclerosis and postoperative neurological dysfunction in elderly coronary surgical patients

Background Arteriosclerosis of the ascending aorta is an important risk factor for cerebral embolism. However, the association between arteriosclerosis of the ascending aorta and neurologic dysfunction after coronary artery surgery has not been evaluated prospectively. Methods We examined whether varying degrees of arteriosclerosis in the ascending aorta, assessed by epiaortic ultrasonography, increased the incidence of neuropsychologic dysfunction and stroke in 463 elderly patients (≥ 60 years old) after coronary artery surgery. Results Patients with severe arteriosclerosis (n = 76) had higher rates of postoperative neuropsychologic dysfunction (26%) and intraoperative stroke (10.5%); the moderately atherosclerotic patients (n = 57) had rates of 7% and 1.8%, respectively; whereas control patients (almost normal or mild arteriosclerosis, n = 330) had rates of 8% and 1.2%, respectively (all p < 0.001). Univariate analysis indicated that multiple small infarctions or broad infarctions, cerebral arterial stenosis, circulatory arrest, maximal thickness of intima around the site of aortic manipulation, and deformities due to clamp or cannulation were associated significantly with intraoperative strokes in patients with severe arteriosclerosis. Conclusions Severe arteriosclerosis of the ascending aorta significantly increased the risk of postoperative neuropsychologic dysfunction and stroke after coronary artery bypass grafting. If a thick plaque is noted near the manipulation site, a nontouch method of the ascending aorta should be applied to reduce the incidence of neurologic dysfunction.

Benefits of optimising drug treatment in home-dwelling elderly patients with coronary artery disease.

Coronary artery disease (CAD) is prevalent in the elderly and often leads to disability. Consequently, strategies for optimising the prevention and treatment of CAD in the elderly are important from both the individual and societal perspectives. Although it is common knowledge that the elderly are heavy consumers of drugs, there is evidence to show that there is under-prescribing of evidence-based medical therapies in the home-dwelling elderly coronary patient and there may be overuse of some non-evidence-based (antioxidants) and purely symptomatic treatments. In particular, aspirin (acetylsalicylic acid), beta-adrenoceptor antagonists, ACE inhibitors and HMG-CoA reductase inhibitors are under-utilised. Although the evidence base is largely drawn from trials including patients younger than 75 years, it is reasonable to assume that the data applies to patients aged over 75 years and that better use of evidence-based medicines would provide benefits to the home-dwelling aged patient. Evidence from the few multifactorial studies available suggest possible benefits including reduction of cardiovascular events, less disability and better quality of life in old age. At the societal level, this would be reflected in fewer hospitalisations and institutionalisations, which means decreased cost of elderly care.

Interpretation of radial pulse contour during fentanyl/nitrous oxide anesthesia and mechanical ventilation.

Peripheral arterial blood pressure is not a reliable substitute for proximal aortic pressure. Recognition of this phenomenon is important for correct appreciation of cardiac afterload. Our aim was to evaluate the utility of the radial pulse wave to better understand ventriculo-vascular coupling during anesthesia. We observed the differences between aortic systolic pressure (AoSAP, tipmanometry) and radial systolic pressure in 15 patients, (including two women) aged 53-78 years, before coronary artery bypass surgery. We studied the induction of anesthesia with fentanyl (20 microg kg-1), moderate volume loading, and thereafter the addition of 70% nitrous oxide. The circulatory effects of mechanical ventilation were studied by doubling the tidal volumes. Pulse wave contours were assessed by calculation of radical and aortic augmentation indices (AI), which measure the second systolic pressure peak. Radial systolic pressure was higher than AoSAP in the control situation (8+/-2 mmHg), and this SAP gradient increased further with fentanyl (12+/-2 mmHg). The gradient persisted throughout the study, but was partially reduced by volume loading and nitrous oxide, respectively. Radial augmentation index was the only parameter remaining in a stepwise multivariate model to explain the variance in the SAP gradient (r2=0.48). Radial augmentation index also correlated with aortic pulse pressure (r2=0.71). Mechanical ventilation had significant and similar effects on pulse wave augmentation both in the aorta and in the radial artery, and did not affect the radial to aortic SAP gradient. These elderly coronary patients had stiff vasculature (high aortic AI) and considerable pulse wave reflection, which was beneficially delayed by fentanyl. Changes in the radial pulse wave augmentation during mechanical ventilation were mainly a result of cyclic changes in the stroke volume, and were seldom associated with an increased systolic pressure gradient from the aorta to the radial artery.

Benefits of Cardiac Rehabilitation and Exercise Training Programs in Elderly Coronary Patients

The authors review several studies from the Ochsner Heart and Vascular Institute showing the benefits of formal phase II cardiac rehabilitation and exercise training programs in elderly patients with coronary artery disease, including benefits on plasma lipids, obesity indices, exercise capacity, peak oxygen consumption, behavioral characteristics (especially depression), and quality of life. Marked benefits were noted in elderly women and all elderly patients over the age of 75 years. The authors conclude that the therapy has proved to be safe and effective for elderly coronary patients, and that these individuals should be routinely referred to, and vigorously encouraged to attend, cardiac rehabilitation programs following major coronary events.

4.33 Prognostic value of myocardial perfusion SPELT in elderly coronary patients

4.33 Prognostic value of myocardial perfusion SPELT in elderly coronary patients

Comparison of lipid profile and fibrinogen levels in male middle aged and elderly coronary patients and healthy individuals

Comparison of lipid profile and fibrinogen levels in male middle aged and elderly coronary patients and healthy individuals