Elderly ischemic heart disease

Arts, I.C.W. et al., Catechin intake might explain the inverse relation between tea consumption and ischemic heart disease the Zutphen Elderly Study, Am. J. Clin. Nutr., 74, 227, 2001. 

In the Caerphilly cohort (UK) of elderly men, for example, an inverse, but not statistically significant, relationship was reported between a higher milk intake (0.5 1 vs. no milk intake) and the risk of both ischemic stroke and ischemic heart disease. This study included 2512 men of whom 493 had an event of ischemic heart disease and 185 had an ischemic stroke during 20-24 years of follow-up. In this study, information on milk drinking was obtained in a semiquantitive food frequency questionnaire (Elwood et al., 2004a) which may have been a limitation. 

Abbreviations CA, carotid atherosclerosis CPIHD, Caerphilly Prospective Ischemic Heart Disease EVCS, Elderly Vitamin C Status IWHS-D, Lowa Women s Health Study MGH, Mortality in a Geriatric Hospital MRCT Medical Research Council Trial NAHNES I, National Health and Nutrition Examination Survey PSCHD, Prospective Study of vitamin C in Coronary Heart Disease SOP Supplementation... 

Vascular disease is of major importance worldwide as a cause both of death and disability, mainly in middle-aged and elderly individuals. Ischemic heart disease and stroke are the two leading causes of deadi in the developing world, as well as in the developed world, and accounted for around one fiflh of the 50 million deaths worldwide in 1990 (1). Cardiovascular disorders caused almost 10% of all disability worldwide in 1990 (2), and projections suggest that by the year 2020 this will have risen to 15%, with almost all of the increase occurring in developing countries (3). 

The hemodjmamic effects of combining ephedrine with propofol in an effort to prevent hypotension and bradycardia have been investigated in 40 elderly patients of ASA grades III and IV, who received ephedrine 15, 20, or 25 mg added to propofol 200 mg (15). The hypotensive response to propofol was effectively prevented, but marked tachycardia in the majority of patients meant that the technique may not be beneficial, given the high incidence of ischemic heart disease in this age group. 

Normally there is a brisk increase both in the thyroid uptake of and in serum levels of total T4 following intramuscular TSH injection. If doses of 10 USP units of TSH are given on three consecutive days, a normal subject will respond with a rise in serum total T4 of at least 3 /ug/100 ml from baseline level, blood being taken 8 hours after the last injection. The 24-hour thyroidal uptake should increase by 2- to 3-fold or by an absolute increment of 15-20 of the dose compared with the initial 24-hour uptake. Care must be taken if using this i-dose schedule in elderly patients or where ischemic heart disease is present. 

Jain, N.B., V. Potula, J. Schwartz, P.S. Vokonas, D. Sparrow, R.O. Wright, H. Nie, and H. Hu. 2007. Lead levels and ischemic heart disease in a prospective study of middle-aged and elderly men The VA Normative Aging Study. Environ. Health Perspect. 115(6) 871-875. 

Some patients have characteristics that dictate compelling indications for certain drugs or combinations. Patients with hypertension and ischemic heart disease, diabetic nephropathy, or cardiac failure may benefit from combinations of drug classes that target both diseases. As hypertension is more common as patients get older, there are often multiple co-morbidities that influence the treatment options. In elderly men hypertension may co-exist with prostate disease, the latter being associated with a variety of lower urinary tract symptoms related to an overactive bladder and/or bladder outlet obstruction. Calcium channel blockers may have beneficial effects on the overactive bladder by reducing detrusor muscle tone, and this has been investigated in a trial of amlodipine plus terazosin compared with terazosin alone in men with mild to moderate hypertension and lower urinary tract symptoms [5 ]. Combination treatment was associated with notable improvement in overactive bladder symptoms and better control of hypertension. 

Congestive heart failure (CHF) due to ischemic heart disease is a very common clinical situation, particularly in the elderly group of patients. It is however unclear how the myocardial cells behave metabolically when decreased blood flow in the myocardial tissue develops as a result of stenosis, or obstruction of coronary vessels, eventually leading to myocardial infarction. Myocardial metabolism was studied by microcalorimetry and oxygen consumption measurement in tissue from rats with CHF after a myocardial infarction, induced by ligation of the left coronary artery [89]. 

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