Coronary artery disease (CAD) is highly prevalent in older adults, yet its management remains challenging. Treatment choices are made complex by the frailty burden of older patients, a high prevalence of comorbidities and body composition abnormalities (e.g., sarcopenia), the complexity of coronary anatomy, and the frequent presence of multivessel disease, as well as the coexistence of major ischemic and bleeding risk factors. Recent randomized clinical trials and epidemiological studies have provided new data on optimal management of complex patients with CAD. However, frail older adults are still underrepresented in the literature. This narrative review aims to highlight the importance of assessing frailty as an aid to guide therapeutic decision-making and tailor CAD management to the specific needs of older adults, taking into account age-related pharmacokinetic and pharmacodynamic changes, polypharmacy, and potential drug interactions. We also discuss gaps in the evidence and offer perspectives on how best in the future to optimize the global strategy of CAD management in older adults.

Cacciatore, S., Spadafora, L., Bernardi, M., Galli, M., Betti, M., Perone, F., Nicolaio, G., Marzetti, E., Martone, A. M., Landi, F., Asher, E., Banach, M., Hanon, O., Biondi-Zoccai, G., Sabouret, P., Management of Coronary Artery Disease in Older Adults: Recent Advances and Gaps in Evidence, <<JOURNAL OF CLINICAL MEDICINE>>, 2023; 12 (16): 1-19. [doi:10.3390/jcm12165233] [https://hdl.handle.net/10807/246474]

Management of Coronary Artery Disease in Older Adults: Recent Advances and Gaps in Evidence

Cacciatore, Stefano;Marzetti, Emanuele;Martone, Anna Maria;Landi, Francesco;
2023

Abstract

Coronary artery disease (CAD) is highly prevalent in older adults, yet its management remains challenging. Treatment choices are made complex by the frailty burden of older patients, a high prevalence of comorbidities and body composition abnormalities (e.g., sarcopenia), the complexity of coronary anatomy, and the frequent presence of multivessel disease, as well as the coexistence of major ischemic and bleeding risk factors. Recent randomized clinical trials and epidemiological studies have provided new data on optimal management of complex patients with CAD. However, frail older adults are still underrepresented in the literature. This narrative review aims to highlight the importance of assessing frailty as an aid to guide therapeutic decision-making and tailor CAD management to the specific needs of older adults, taking into account age-related pharmacokinetic and pharmacodynamic changes, polypharmacy, and potential drug interactions. We also discuss gaps in the evidence and offer perspectives on how best in the future to optimize the global strategy of CAD management in older adults.
2023
Inglese
Cacciatore, S., Spadafora, L., Bernardi, M., Galli, M., Betti, M., Perone, F., Nicolaio, G., Marzetti, E., Martone, A. M., Landi, F., Asher, E., Banach, M., Hanon, O., Biondi-Zoccai, G., Sabouret, P., Management of Coronary Artery Disease in Older Adults: Recent Advances and Gaps in Evidence, <<JOURNAL OF CLINICAL MEDICINE>>, 2023; 12 (16): 1-19. [doi:10.3390/jcm12165233] [https://hdl.handle.net/10807/246474]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/246474
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