Medications and Cardiovascular Health in Older Adults: Room for Improvement in Prevention and Treatment

Authors

  • Caroline S. Rhoads MD,

    1. From the Department of Medicine,1the Cardiovascular Health Research Unit, and the Departments of Epidemiology and Health Services,2University of Washington, Seattle, WA; Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD;3 and the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC4
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  • 1 Bruce M. Psaty MD, PhD,

    1. From the Department of Medicine,1the Cardiovascular Health Research Unit, and the Departments of Epidemiology and Health Services,2University of Washington, Seattle, WA; Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD;3 and the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC4
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  • 1,2 Jean L. Olson MD, MPH,

    1. From the Department of Medicine,1the Cardiovascular Health Research Unit, and the Departments of Epidemiology and Health Services,2University of Washington, Seattle, WA; Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD;3 and the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC4
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  • and 3 Curt D. Furberg MD, PhD 4

    1. From the Department of Medicine,1the Cardiovascular Health Research Unit, and the Departments of Epidemiology and Health Services,2University of Washington, Seattle, WA; Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD;3 and the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC4
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Bruce M. Psaty, MD, PhD, Cardiovascular Health Research Unit, 1730 Minor Avenue, Suite 1360, Seattle, WA 98101-1448
E-mail: psaty@u.washington.edu

Abstract

While cardiovascular disease remains the most common cause of death in older adults, treatments are now available that are associated with significant improvements in both morbidity and mortality. The Cardiovascular Health Study trials of drug use in older adults reviewed here show that in a racially and geographically diverse cohort of community-dwelling elders, effective treatments were underused during the 1990s. Most participants with hyperlipidemia, atrial fibrillation, and congestive heart failure did not receive therapies known to reduce morbidity and mortality, and when treatment was initiated, those at highest risk were no more likely to start treatment than those at lower risk. The use of drugs with evidence of efficacy in the prevention of stroke and congestive heart failure in hypertensive participants decreased with time, and control of hypertension and hyperlipidemia were particularly low in diabetics. The impact of this undertreatment on older persons and on society is likely to be substantial.

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