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Nov 18, 2013

New Guidelines for Treating Older Patients with Heart Disease

Scientific statement from the American Heart Association updates guidelines for secondary prevention in older adults.

The American Heart Association recently released a scientific statement on the treatment of older patients with heart disease, which updated guidelines previously released in 2002. With a wealth of new research conducted over the last decade, our understanding of secondary prevention—helping patients with heart disease live healthier, longer—has expanded. Plus, with a graying population, more people are living with heart disease than ever before and it’s important to set guidelines for the best possible treatment of older adults. So what have we learned in the last 10 years about improving outcomes in patients (especially older patients) living with heart disease?

Here are some of the topics addressed in the updated guidelines for treating older patients with heart disease: 


  • Symptoms: Although chest pain is the hallmark symptom of heart disease, it becomes less common with age in both men and women. “Atypical” symptoms that are more common in older age include shortness of breath, sweating, nausea and vomiting, and fainting. Recognition of these symptoms is crucial to diagnosis and proper treatment.

  • Complications: As patients get older, their risk of death and complications such as stroke and heart attack increase. It’s also likely that other health conditions can further complicate cardiovascular health. However, lifestyle changes and certain medications like blood thinners and blood pressure-lowering drugs can reduce risk of complications.

  • Cardiovascular risk: The likelihood of having cardiovascular risk factors such as high blood pressurehigh cholesterol and diabetes increases with age. Also, obesity is a major risk factor among all adults, including older adults. Addressing these risk factors through lifestyle changes and medication, when necessary, are key to preventing heart attack and stroke.

  • Peripheral artery diseasePeripheral artery disease (PAD) occurs when narrowed arteries reduce blood flow to the limbs, increasing risk for heart attack and stroke. Risk for PAD increases with age and can be tested for using a screening called ankle-brachial index. The goal of PAD treatment is to minimize symptoms and reduce risk for complications.

  • Smoking: Cigarette smoking is less common among older adults compared to younger individuals, but continued smoking increases risk of serious complications at any age. It’s never too late to quit, as research has identified the benefits of smoking cessation in individuals older than 80 years old.

  • Mental health: Depression, stress and anxiety can increase cardiovascular risk and worsen existing heart conditions. Further research is needed on treating these conditions in older patients with heart disease, but initial evidence suggests that exercise and medication may help treat depression, stress and anxiety.

  • Treatment: Diet and exercise are key components of secondary prevention in older adults with heart disease. When necessary, medication and medical procedures may help further reduce cardiovascular risk, but it’s important that patients weigh the pros and cons of such treatment with their doctor.

Questions for You to Consider

  • What can I do to control coronary artery disease?
  • If you have been diagnosed with coronary artery disease or had a heart attack, there’s a lot you can do to improve your heart health. A treatment plan that combines diet, exercise, and medicine can help prevent another heart attack or the need for bypass surgery in the future. Steps you can take to protect your arteries include:

    • Keep high blood pressure under control. 
    • Keep your cholesterol levels within a healthy range.
    • Don’t smoke.
    • Lose weight if you are overweight.
    • Treat high blood sugar.
    • Get regular physical activity.
    • Adopt a heart healthy diet.
    • Brush and floss your teeth daily and get regular dental checkups.
    • Take your medicines as your doctor has directed.
  • What should I do to reduce my heart attack risk?

  • Based on study findings and previous guidelines, you can help reduce your risk for heart attack by controlling your cholesterol and blood pressure, quitting smoking (if you’re a smoker), and maintaining a healthy weight. You should also try to maintain a healthy diet and exercise regularly.

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