The Burden of Cardiovascular Disease in the Elderly: Morbidity, Mortality, and Costs

doi:10.1016/J.CGER.2009.07.007

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The Burden of Cardiovascular Disease in the Elderly: Morbidity, Mortality, and Costs

Journal Article•DOI•

The Burden of Cardiovascular Disease in the Elderly: Morbidity, Mortality, and Costs

Ali Yazdanyar¹, Anne B. Newman¹•Institutions (1)

University of Pittsburgh¹

01 Nov 2009-Clinics in Geriatric Medicine (Elsevier)-Vol. 25, Iss: 4, pp 563-577

TL;DR: An overview of the epidemiology of CVD in older adults is provided, including an assessment of the impact of CVC on mortality, morbidity, and health care costs.

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About: This article is published in Clinics in Geriatric Medicine.The article was published on 2009-11-01 and is currently open access. It has received 449 citations till now. The article focuses on the topics: Successful aging & Population.

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Journal Article•DOI•

Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly

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John J McNeil¹, Rory Wolfe¹, Robyn L. Woods¹, Andrew Tonkin¹, Geoffrey A. Donnan¹, Mark Nelson¹, Christopher M. Reid¹, Jessica E. Lockery¹, Brenda Kirpach¹, Elsdon Storey¹, Raj C. Shah¹, Jeff D. Williamson¹, Karen L. Margolis¹, Michael E. Ernst¹, Walter P. Abhayaratna¹, Nigel Stocks¹, Sharyn M. Fitzgerald¹, Suzanne G Orchard¹, Ruth E Trevaks¹, Lawrence J. Beilin¹, Colin I. Johnston¹, Joanne Ryan¹, Barbara Radziszewska¹, Michael Jelinek¹, Mobin Malik¹, Charles B. Eaton¹, Donna Brauer¹, Geoff Cloud¹, Erica M. Wood¹, Suzanne E. Mahady¹, Suzanne Satterfield¹, Richard H. Grimm¹, Anne M. Murray¹ - Show less +29 more•Institutions (1)

Florey Institute of Neuroscience and Mental Health¹

16 Sep 2018-The New England Journal of Medicine

TL;DR: The use of low‐dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in aificantly lower risk of cardiovascular disease than placebo.

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Abstract: Background Aspirin is a well-established therapy for the secondary prevention of cardiovascular events. However, its role in the primary prevention of cardiovascular disease is unclear, especially in older persons, who have an increased risk. Methods From 2010 through 2014, we enrolled community-dwelling men and women in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or disability. Participants were randomly assigned to receive 100 mg of enteric-coated aspirin or placebo. The primary end point was a composite of death, dementia, or persistent physical disability; results for this end point are reported in another article in the Journal. Secondary end points included major hemorrhage and cardiovascular disease (defined as fatal coronary heart disease, nonfatal myocardial infarction, fatal or nonfatal stroke, or hospitalization for heart failure). Results Of th...

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714 citations

Journal Article•DOI•

Cardiovascular Risks Associated with Gender and Aging.

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Jennifer L. Rodgers¹, Jarrod Jones¹, Samuel Ignatious Bolleddu¹, Sahit Vanthenapalli¹, Lydia E. Rodgers¹, Kinjal Shah¹, Krishna Karia¹, Siva K. Panguluri¹ - Show less +4 more•Institutions (1)

University of South Florida¹

27 Apr 2019-Journal of Cardiovascular Development and Disease

TL;DR: Current findings regarding the impacts of age and gender on heart disease are discussed and hormone replacement therapies are largely shown to not improve outcomes in older patients and may also increase the risks of cardiac events in older adults.

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Abstract: The aging and elderly population are particularly susceptible to cardiovascular disease. Age is an independent risk factor for cardiovascular disease (CVD) in adults, but these risks are compounded by additional factors, including frailty, obesity, and diabetes. These factors are known to complicate and enhance cardiac risk factors that are associated with the onset of advanced age. Sex is another potential risk factor in aging adults, given that older females are reported to be at a greater risk for CVD than age-matched men. However, in both men and women, the risks associated with CVD increase with age, and these correspond to an overall decline in sex hormones, primarily of estrogen and testosterone. Despite this, hormone replacement therapies are largely shown to not improve outcomes in older patients and may also increase the risks of cardiac events in older adults. This review discusses current findings regarding the impacts of age and gender on heart disease.

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348 citations

Cites background from "The Burden of Cardiovascular Diseas..."

...The burden of CVD is directly related to increased mortality, morbidity, and frailty in affected individuals, which also translates to significant overall healthcare costs [3]....
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...The American Heart Association (AHA) reports that the incidence of CVD in US men and women is ~40% from 40–59 years, ~75% from 60–79 years, and ~86% in those above the age of 80 [3]....
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...Given that the aged US population is expected to increase by 2050, by as much as two- and three-fold, the need for a better understanding of the etiologies associated with CVD in older adults is critically needed [3]....
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...The prevalence of CVD has also been shown to increase with age, in both men and women, including the prevalence of atherosclerosis, stroke and, myocardial infarction [3]....
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Journal Article•DOI•

The global impact of non-communicable diseases on healthcare spending and national income: a systematic review

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Taulant Muka¹, David Imo¹, Loes Jaspers¹, Verônica Colpani¹, Layal Chaker¹, Sven J. van der Lee¹, Shanthi Mendis², Rajiv Chowdhury³, Wichor M. Bramer¹, Abby Falla¹, Raha Pazoki¹, Oscar H. Franco¹ - Show less +8 more•Institutions (3)

Erasmus University Rotterdam¹, World Health Organization², University of Cambridge³

18 Jan 2015-European Journal of Epidemiology

TL;DR: Low- and middle-income countries were the focus of just 16 papers, which suggests an information shortage concerning the true economic burden of NCDs in these countries.

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Abstract: The impact of non-communicable diseases (NCDs) in populations extends beyond ill-health and mortality with large financial consequences To systematically review and meta-analyze studies evaluating the impact of NCDs (including coronary heart disease, stroke, type 2 diabetes mellitus, cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease and chronic kidney disease) at the macro-economic level: healthcare spending and national income Medical databases (Medline, Embase and Google Scholar) up to November 6th 2014 For further identification of suitable studies, we searched reference lists of included studies and contacted experts in the field We included randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults assessing the economic consequences of NCDs on healthcare spending and national income without language restrictions All abstracts and full text selection was done by two independent reviewers Any disagreements were resolved through consensus or consultation of a third reviewer Data were extracted by two independent reviewers using a pre-designed data collection form Studies evaluating the impact of at least one of the selected NCDs on at least one of the following outcome measures: healthcare expenditure, national income, hospital spending, gross domestic product (GDP), gross national product, net national income, adjusted national income, total costs, direct costs, indirect costs, inpatient costs, outpatient costs, per capita healthcare spending, aggregate economic outcome, capital loss in production levels in a country, economic growth, GDP per capita (per capita income), percentage change in GDP, intensive growth, extensive growth, employment, direct governmental expenditure and non-governmental expenditure From 4,364 references, 153 studies met our inclusion criteria Most of the studies were focused on healthcare related costs of NCDs 30 studies reported the economic impact of NCDs on healthcare budgets and 13 on national income Healthcare expenditure for cardiovascular disease (12-165 %) was the highest; other NCDs ranged between 07 and 74 % NCD-related health costs vary across the countries, regions, and according to type of NCD Additionally, there is an increase in costs with increased severity and years lived with the disease Low- and middle-income (LMI) countries were the focus of just 16 papers, which suggests an information shortage concerning the true economic burden of NCDs in these countries NCDs pose a significant financial burden on healthcare budgets and nations' welfare, which is likely to increase over time However further work is required to standardize more consistently the methods available to assess the economic impact of NCDs and to involve (hitherto under-addressed) LMI populations across the globe

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230 citations

Cites background from "The Burden of Cardiovascular Diseas..."

...Using a systematic search in Pubmed and Embase, 14 review articles [97–110] (including four systematic reviews [97–99, 104]) evaluating the economic impact of different NCDs on healthcare expenditure were found....
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Journal Article•DOI•

Inflammaging and Oxidative Stress in Human Diseases: From Molecular Mechanisms to Novel Treatments

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Li Zuo¹, Prather Er², Stetskiv M², Garrison De², Meade², Peace Ti¹, Tingyang Zhou² - Show less +3 more•Institutions (2)

University of Maine at Presque Isle¹, Ohio State University²

10 Sep 2019-International Journal of Molecular Sciences

TL;DR: This review focuses on inflammaging and its contribution to various age-related diseases such as cardiovascular disease, cancer, neurodegenerative diseases, chronic obstructive pulmonary disease, diabetes, and rheumatoid arthritis.

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Abstract: It has been proposed that a chronic state of inflammation correlated with aging known as inflammaging, is implicated in multiple disease states commonly observed in the elderly population. Inflammaging is associated with over-abundance of reactive oxygen species in the cell, which can lead to oxidation and damage of cellular components, increased inflammation, and activation of cell death pathways. This review focuses on inflammaging and its contribution to various age-related diseases such as cardiovascular disease, cancer, neurodegenerative diseases, chronic obstructive pulmonary disease, diabetes, and rheumatoid arthritis. Recently published mechanistic details of the roles of reactive oxygen species in inflammaging and various diseases will also be discussed. Advancements in potential treatments to ameliorate inflammaging, oxidative stress, and consequently, reduce the morbidity of multiple disease states will be explored.

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227 citations

Cites background from "The Burden of Cardiovascular Diseas..."

...In general, CVD is responsible for large levels of mortality, morbidity, loss of function, and disability [22]....
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Journal Article•DOI•

Population-level COVID-19 mortality risk for non-elderly individuals overall and for non-elderly individuals without underlying diseases in pandemic epicenters.

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John P. A. Ioannidis¹, Cathrine Axfors², Despina G. Contopoulos-Ioannidis¹•Institutions (2)

Stanford University¹, Uppsala University²

01 Sep 2020-Environmental Research

TL;DR: People<65 years old have very small risks of COVID-19 death even in pandemic epicenters and deaths for people <65 years without underlying predisposing conditions are remarkably uncommon.

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214 citations

Cites background from "The Burden of Cardiovascular Diseas..."

...Population-level COVID-19 mortality risk for non-elderly individuals overall and for non-elderly individuals without underlying diseases in pandemic epicenters John P.A. Ioannidis a,b,*, Cathrine Axfors b,c, Despina G. Contopoulos-Ioannidis d a Stanford Prevention Research Center, Department of Medicine, and Department of Epidemiology and Population Health, Stanford University School of Medicine, USA b Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA c Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden d Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA A R T I C L E I N F O Keywords: COVID-19 Mortality Risk Age Underlying diseases A B S T R A C T Objective: To provide estimates of the relative rate of COVID-19 death in people 65 years old versus older individuals in the general population, the absolute risk of COVID-19 death at the population level during the first epidemic wave, and the proportion of COVID-19 deaths in non-elderly people without underlying diseases in epicenters of the pandemic....
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...For the whole COVID-19 fatality season to-date (starting with the date the first death was documented in each location), the average daily risk of dying from coronavirus for a person 65 years old is equivalent to the risk of dying driving a distance of 4–82 miles by car per day during that COVID-19 fatality season in 18 of the 27 hotbeds and 106–483 miles per day in the other 9 hotbeds (UK and 8 USA locations)....
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...This pattern requires further investigation, but it may reflect unfavorable socioeconomic circumstances for victims of COVID19 in the USA....
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...Conversely, the risk is higher in the UK and in the other 8 states in the USA (driving 106–483 miles per day) for the 92–111 days during which they have witnessed COVID-19 deaths....
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...For example, in India, life expectancy is almost a decade less than in the USA and almost 15 years less than in Switzerland, making octogenarians and nonagenarians few in relative terms....
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References

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Journal Article•DOI•

Heart Disease and Stroke Statistics—2009 Update

[...]

Donald M. Lloyd-Jones, Robert J. Adams, Mercedes R. Carnethon, Giovanni de Simone, T. Bruce Ferguson, Katherine M. Flegal, Earl S. Ford, Karen L. Furie, Alan S. Go, Kurt J. Greenlund, Nancy Haase, Susan M. Hailpern, Michael Ho, Virginia J. Howard, Brett M. Kissela, Steven J. Kittner, Daniel T. Lackland, Lynda D. Lisabeth, Ariane Marelli, Mary M. McDermott, James B. Meigs, Dariush Mozaffarian, Graham Nichol, Christopher J. O'Donnell, Véronique L. Roger, Wayne D. Rosamond, Ralph L. Sacco, Paul D. Sorlie, Randall S. Stafford, Julia Steinberger, Thomas Thom, Sylvia Wasserthiel-Smoller, Nathan D. Wong, Judith Wylie-Rosett, Yuling Hong - Show less +31 more

27 Jan 2009-Circulation

TL;DR: The statistical update brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update.

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Abstract: We thank Drs Sean Coady, Eric L. Ding, Brian Eigel, Gregg C. Fonarow, Linda Geiss, Cherie James, Michael Mussolino, and Michael Wolz for their valuable comments and contributions. We acknowledge Tim Anderson and Tom Schneider for their editorial contributions, and Karen Modesitt for her administrative assistance. Disclosures ⇓⇓⇓⇓ View this table: Writing Group Disclosures View this table: Writing Group Disclosures, Continued View this table: Writing Group Disclosures, Continued View this table: Writing Group Disclosures, Continued # Summary {#article-title-2} Each year, the American Heart Association, in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay …

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5,019 citations

"The Burden of Cardiovascular Diseas..." refers background in this paper

...Stroke is the third leading cause of death and a leading cause of long-term disability in the United States....
[...]
...Likewise, the proportion of individuals aged 70 years or older that die within 1 year following a first MI is twofold to threefold higher than in those aged 40 to 69 years.(3)...
[...]
...years, it increases to approximately 8% by 60 to 79 years, and reaches 13% to 17% among persons aged 80 years or older.(3) The overall 10-year incidence of stroke in the CHS ranged from 13....
[...]
...In 2005, CHD was the primary cause of 445,687 deaths, of which nearly 82% were in individuals aged 65 years or older.(3) The prevalence of CHD increases markedly with age in men and women (Fig....
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...4).(3) Similarly, the incidence of CHD increases with age among older adults, irrespective of race or gender (Figs....
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Book•

Successful Aging

[...]

Robert L. Kahn

17 Feb 1998

TL;DR: The authors of as discussed by the authors stated that much of the decline associated with old age has more to do with lifestyle than aging, and that social interaction is a powerful safeguard of emotional well-being.

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Abstract: Much of the decline associated with old age has more to do with lifestyle than aging. The old adage that says "you lose it if you don't use it" is true. In order to maintain and promote cognitive wellness, Carol Miller, a gerontologist, in her book "Wellness In Older Adults" states that engaging in new learning experiences, participating in challenging leisure activities, and preserving and continuing social relationships with friends and family members is imperative to total wellness. Dr. Andrew Weil in his book "Spontaneous Healing" states, "We humans are social animals. Reach out to others. Make social interaction a priority. It is a powerful safeguard of emotional well-being."

...read moreread less

4,531 citations

Journal Article•DOI•

Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.

[...]

Donald M. Lloyd-Jones, Robert J. Adams, Mercedes R. Carnethon, Giovanni de Simone, T. Bruce Ferguson, Katherine M. Flegal, Earl S. Ford, Karen L. Furie, Alan S. Go, Kurt J. Greenlund, Nancy Haase, Susan M. Hailpern, Michael Ho, Virginia J. Howard, Brett M. Kissela, Steven J. Kittner, Daniel T. Lackland, Lynda D. Lisabeth¹, Ariane Marelli, Mary M. McDermott, James B. Meigs, Dariush Mozaffarian, Graham Nichol, Christopther O'Donnell, Véronique L. Roger, Wayne D. Rosamond, Ralph L. Sacco, Paul D. Sorlie, Randall S. Stafford, Julia Steinberger, Thomas Thorn, Sylvia Wasserthiel-Smoller, Nathan D. Wong, Judith Wylie-Rosett, Yuling Hong - Show less +31 more•Institutions (1)

University of Michigan¹

27 Jan 2009-Circulation

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4,003 citations

Journal Article•DOI•

The cardiovascular health study: Design and rationale

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Linda P. Fried¹, Nemat O. Borhani², Paul L. Enright³, Curt D. Furberg⁴, Julius M. Gardin⁵, Richard A. Kronmal⁶, Lewis H. Kuller⁷, Teri A. Manolio⁸, Maurice B. Mittelmark⁴, Anne B. Newman⁷, Daniel H. O'Leary⁹, Bruce M. Psaty⁶, Pentti M. Rautaharju¹⁰, Russell P. Tracy¹¹, Philip G. Weiler² - Show less +11 more•Institutions (11)

Johns Hopkins University¹, University of California, Davis², Mayo Clinic³, Wake Forest University⁴, University of California, Irvine⁵, University of Washington⁶, University of Pittsburgh⁷, National Institutes of Health⁸, Harvard University⁹, Dalhousie University¹⁰, University of Vermont¹¹

01 Feb 1991-Annals of Epidemiology

TL;DR: These examinations in CHS permit evaluation of CVD risk factors in older adults, particularly in groups previously under-represented in epidemiologic studies, such as women and the very old.

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3,631 citations

"The Burden of Cardiovascular Diseas..." refers methods in this paper

...Data presented in this article are derived primarily from population-based epidemiologic studies of community-dwelling adults in the United States, including those focusing on older adults, such as the Cardiovascular Health Study (CHS).(2)...
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Journal Article•DOI•

Burden of valvular heart diseases: a population-based study.

[...]

Vuyisile T. Nkomo¹, Julius M. Gardin, Thomas N. Skelton², John S. Gottdiener³, Christopher G. Scott¹, Maurice Enriquez-Sarano¹ - Show less +2 more•Institutions (3)

Mayo Clinic¹, University of Mississippi Medical Center², University of Maryland, Baltimore³

16 Sep 2006-The Lancet

TL;DR: In this paper, the authors assess the prevalence and effect of valve disease on overall survival in the general population and find that moderate or severe valve disease is common in this population and increase with age.

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3,468 citations