Enrollment and maintenance of elderly patients in cardiovascular clinical trials.

This review addresses the paucity of data available to guide clinical cardiovascular management at advanced elderly age, a likely contributor to the lesser use of beneficial therapies in this population. Cardiovascular disease is the largest health burden of aged persons; this mandates inclusion of elderly persons in clinical research studies of preventive interventions, diagnostic procedures, pharmacotherapy, and high-technology interventional procedures to ascertain their applicability to patients of advanced age. Relevant clinical outcomes include improvement in functional independence and quality of life, decrease in costly hospitalizations, and prolongation of meaningful life.

Lipid abnormalities in women: data for risk, data for management.

In multiple randomized, controlled clinical trials, statin treatment of elevated low-density lipoprotein cholesterol in women at increased risk of or with coronary heart disease decreased the risk of coronary events: coronary death, nonfatal myocardial infarction, and myocardial revascularization procedures. Total mortality was unchanged, potentially reflecting the underrepresentation of women in these trials and consequent small number of fatal events. Statin therapy provided comparable benefit for women and men with acute coronary syndromes.

Time course of depression and outcome of myocardial infarction.

Background: Depression predicts worse outcomes after myocardial infarction (MI), but whether its time course in the month following MI has prognostic importance is unknown. Our objective was to evaluate the prognostic importance of transient, new, or persistent depression on outcomes at 6 months after MI.

Methods: In a prospective registry of acute MI (Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery [PREMIER]), depressive symptoms were measured in 1873 patients with the Patient Health Questionnaire (PHQ) during hospitalization and 1 month after discharge and were classified as transient (only at baseline), new (only at 1 month), or persistent (at both times).

Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women.

Background: The effect of raloxifene, a selective estrogen-receptor modulator, on coronary heart disease (CHD) and breast cancer is not established.

Methods: We randomly assigned 10,101 postmenopausal women (mean age, 67.5 years) with CHD or multiple risk factors for CHD to 60 mg of raloxifene daily or placebo and followed them for a median of 5.

Gender differences in short-term cardiovascular outcomes after percutaneous coronary interventions.

Recent studies have been inconsistent in demonstrating a decrease in the gender gap in short-term post-percutaneous coronary intervention (PCI) outcomes. We sought to determine gender differences in outcomes in younger and older patients who underwent PCI during the current stent era. We studied 4,768 elective PCI procedures performed at Emory University Hospital from 2001 to 2004.

Anticoagulation in women with non-valvular atrial fibrillation in the stroke prevention using an oral thrombin inhibitor (SPORTIF) trials.

Aims: The risk of stroke is greater among women with atrial fibrillation (AF) than men. Warfarin protects against stroke, but treatment-related bleeding occurs more often in women than in men.

Methods And Results: SPORTIF III (open label, n=3410) and V (double-blind, n=3922) included 2257 women with AF and one or more stroke risk factors randomized to warfarin [target international normalized ratio (INR) 2.

Depressive symptoms after acute myocardial infarction: evidence for highest rates in younger women.

Background: Depression is common in patients hospitalized with acute myocardial infarction (AMI). In the community, younger women are uniquely prone to depression. Whether younger women are also more likely to have depression during hospitalization with AMI is unknown.

Management strategies of dyslipidemia in the elderly: 2005.

During the past 3 years, the treatment of dyslipidemia has evolved significantly. The impact of recent trial data on management strategies in older patients is especially important, because the elderly segment of the US population continues to grow. Several clinical trials have been completed since the publication of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III guidelines were published in 2001.

Coronary heart disease in women: highlights of the past 2 years--stepping stones, milestones and obstructing boulders.

Emerging data continue to highlight important sex-based differences in coronary heart disease (CHD) prevention and diagnostic testing, in the management of acute coronary syndromes and in the outcomes of CHD therapies. Evidence-based guidelines have been developed that offer specific recommendations for clinicians and information for women. These guidelines are buttressed by results that have become available from randomized, controlled clinical trials in women, and data from CHD registries and clinical trials involving both sexes but including adequate numbers of women to enable the reporting of sex-specific results.

The metabolic syndrome: recognition and management.

The National Cholesterol Education Program defines the metabolic syndrome as three or more of five abnormalities: waist circumference of >40 in (102 cm) for men or >35 in (88 cm) for women, triglyceride level of > or =150 mg/dL, high-density lipoprotein cholesterol of <40 mg/dL in men or <50 mg/dL in women, blood pressure of > or =130 or > or =85 mm Hg, and fasting glucose of > or =110 mg/dL. It is related to insulin resistance, but the two terms are not synonymous. Both are associated strongly with obesity.

Treating dyslipidemia in the elderly.

Purpose Of Review: The treatment of dyslipidemia has been dynamic over the past several years. Of special importance is the impact of recent clinical trial data on management strategies of dyslipidemia in the elderly. People 65 years and older are living longer and are the fastest growing subset of the US population, necessitating more attention to chronic disease conditions that manifest in this age group.

Recognition and prevention of cardiovascular disease in women.

Cardiovascular disease (CVD) is the leading cause of mortality for women and among women, the number of deaths secondary to CVD is nearly twice the number of all cancer-related deaths. Mortality trends from 1979 to 2001 have shown a consistent decrease in cardiovascular mortality among men; however, cardiovascular mortality trends have remained steady or increased among women. This disparity in outcomes, in part, is secondary to a lack of awareness among women and their health care providers regarding a woman's risk for CVD.

Evidence-based management of coronary artery disease in the elderly--current perspectives.

Cardiovascular disease accounts for significant morbidity and mortality in the elderly. The clinical trial data available to guide therapy in this growing population subset are relatively limited. This review will focus on treatment approaches and recommendations obtained from subgroup analyses of elderly patients from major clinical trials for the management of chronic stable angina, acute coronary syndromes (unstable angina and non-ST-segment elevation myocardial infarction), and coronary revascularization.

Evidence-based management of acute myocardial infarction in the elderly--current perspectives.

Cardiovascular disease accounts for significant morbidity and mortality in the elderly. Despite several, large cardiovascular clinical trials, data to guide therapy in this growing population subset are relatively limited. This review focuses on treatment approaches and recommendations for the management of elderly patients with acute myocardial infarction (MI) obtained from subgroup analyses from major clinical trials.

Baseline characteristics of menopausal women with coronary heart disease in cardiovascular outcomes clinical trials of menopausal hormone therapy or raloxifene.

Despite differences in enrollment criteria, the baseline characteristics of the menopausal women with coronary heart disease enrolled in the cardiovascular outcome trials of menopausal hormone therapy or raloxifene are remarkably similar. Globally, cardiovascular risk factors were not optimally controlled at entry into these trials. More aggressive cardiovascular risk factor interventions are requisite to achieve optimal target goals for women with documented coronary heart disease.

Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002.

Background: Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time.

Methods: With the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be "ideal candidates" for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002.

Results: In the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy (for white men, white women, black men, and black women: 86.

Secondary prevention of coronary heart disease in elderly patients.

Coronary heart disease remains a leading cause of mortality in the United States, with 84 percent of persons 65 years or older dying from this disease. Secondary preventive measures, including lifestyle modification and pharmacotherapy, are important for elderly patients because of the variable impacts on morbidity and mortality rates and quality of life. Participating in light to moderate activities significantly decreases mortality rates in elderly patients.