Is it worth offering cardiovascular disease prevention to the elderly?

Abstract

The question whether prevention in the elderly or in the old is still worthwhile arises frequently in clinical practice. The life expectancy (LE) of elderly persons is often underestimated and ranges for a 65-year-old European person from 17 to 23 years and for an 80-year-old from 8 and 11 years. In the elderly patients with cardiovascular disease, preventive measures are of great benefit. Smoking cessation results in substantial gains in LE and is more effective than most other interventions. Lipid lowering with statins is cost effective and the intensity of low-density lipoprotein cholesterol lowering correlates with the risk reduction of cardiac events and stroke without increasing the risk of cancer. A quality-adjusted life year costs US $ 18,800, less than the costs of a nursing home for 1 year. Exercise training decreases cardiovascular events and improves quality of life. The benefits of the Mediterranean diet are based on a small randomized trial, which is supplemented by a large observational database. A reduction in all-cause, cardiovascular disease, and cancer mortality is highly likely. Blood pressure lowering reduces stroke and all-cause mortality above the age of 80; however, the target blood pressure should be around 150/80 mmHg or slightly lower. Annual vaccination against influenza is one of the most cost-effective methods to prolong life and should not be forgotten in patients with cardiovascular disease above the age of 65. Thus a number of options are available to add quality-adjusted life years in the elderly by adhering to the general guidelines for cardiovascular prevention. © 2011 The European Society of Cardiology.