There is a dramatic increase in the prevalence of peripheral artery disease (PAD), carotid artery stenosis (CAS) and abdominal aortic aneurysms (AAA) with advanced age, according to a study published on April 15 in the Journal of the American College of Cardiology. In fact, more than 20 percent of octogenarians and 30 percent of nonagenarians have vascular disease in at least one arterial territory.

Additional Resources Full Study ACC's Geriatric Cardiology Member Section  2010 Performance Measures for Adults With PAD ACCF/AHA 2005 and 2011 Guideline Recommendations for Management of Patients With PAD

The study, which used data from a population-based screening study of more than 3.6 million people in the U.S., found that the prevalence of any peripheral vascular disease increased from 1 in 50 in the 40-to-50-year-old age group, to nearly 1 in 3 in the 90-to-100-year-old age group. In addition, the prevalence of PAD, CAS and AAA increased not only with overall advanced age, but for both men and women, respectively. The study investigators also noted that the association between age and peripheral vascular disease remained between symptomatic and asymptomatic patients, as well as after adjusting for baseline demographics and clinical risk factors.

Interestingly, study investigators did note that all three vascular diseases showed different patterns of progression with advanced age. "Both CAS and PAD result from systemic atherosclerosis, yet PAD was far more prevalent among older subjects," they said. Moving forward, they suggest that further research is needed into the potential benefits of screening and treatment in "appropriately aged population."

"This fascinating study highlights the generalizable principle that cardiovascular disease in the very old is both highly prevalent but also distinctive from cardiovascular disease in younger adults," said Daniel E. Forman, MD, FACC, chair of Geriatric Cardiology Membership Section. "As cardiovascular specialists respond to demographics of an aging population that is intrinsically prone to vascular pathology, it becomes incumbent on geriatric cardiology experts to determine risk factors and management strategies particularly suited for an older population. Issues of multimorbidity, polypharmacy, prolonged duration of risk factors, and cumulative oxidative stresses are all pertinent and may fundamentally modify the precepts we apply to younger populations."

"For now, this study demonstrates the imperative to remain vigilant for the likelihood of cardiovascular disease in relation to age. Many patients may benefit from care for this highly prevalent disease with symptomatic, qualitative and perhaps even mortality benefits. However, it also infers a need to refine therapeutic strategies specifically oriented to very old patients, who are also prone to iatrogenesis from many of the standard management options used in younger populations. Certainly, the antiatherogenic utility of physical activity cited by the study's investigators points to the value of cardiac rehabilitation as a means to possibly augment exercise activity among seniors since sedentary behaviors may be particularly detrimental," he added.

Keywords: Atherosclerosis, Demography, Oxidative Stress, Risk Factors, Peripheral Arterial Disease, Peripheral Vascular Diseases, Prevalence, Motor Activity, Sedentary Behavior, Carotid Stenosis, Aortic Aneurysm, Abdominal, United States

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