Primary Prevention of Cardiovascular Disease in Older AdultsRob Walker - 21 Feb, 2019
The primary prevention of cardiovascular disease in older adults is going to be a red Hot Topic as we go through 2019 and beyond. Hypertension remains the most important risk
factor for death and cardiovascular disease worldwide and The European Hypertension guidelines were published late in 2018 recommending lower BP targets even for older adults. Along side this there are some major changes to QOF for 2019/20 (which we will report on in more detail next month) including the addition of a number of Hypertension indicators, one of which is specifically for patients over the age of 80. But what about polypharmacy and falls risk? As discussed in a BMJ editorial in 2018, age alone should not be a barrier to hypertension treatment - many ambulatory older adults, even those aged over 80, are likely to benefit from treating hypertension, but for those who are very frail, have complex comorbidity or limited life expectancy, antihypertensive drugs are likely to be irrelevant or harmful.
And what about primary prevention with statins in the older adult? A perennially controversial topic, but we have had two important pieces of primary research in this area over the last 12 months to help guide us, and hot off the press in February 2019 the CTTC published a meta-analysis looking at the safety and efficacy of statins in older people. And where are we with aspirin for primary prevention in older adults? Again an important study to help answer this has come out in the last 6 months - the ASPREE trial.
Ultimately what this boils down to is what we do best in General Practice - weighing up the evidence, identifying the priorities of the individual in front of us and making shared
decisions together. The primary prevention of cardiovascular disease in older adults is going to be one of our Hot Topics for the upcoming Spring 2019 courses, as we feel it is such an important area to review given all the recent research and guidelines relevant to this population. We will talk you through the evidence base and the relevant guidelines using case-based scenarios to illustrate key points, and give you a framework to help navigate all those difficult conundrums posed in our elderly population. We very much look forward to seeing you soon!