TY - JOUR
T1 - Management of Coronary Artery Disease in Older Adults
T2 - Recent Advances and Gaps in Evidence
AU - Cacciatore, Stefano
AU - Spadafora, Luigi
AU - Bernardi, Marco
AU - Galli, Mattia
AU - Betti, Matteo
AU - Perone, Francesco
AU - Nicolaio, Giulia
AU - Marzetti, Emanuele
AU - Martone, Anna Maria
AU - Landi, Francesco
AU - Asher, Elad
AU - Banach, Maciej
AU - Hanon, Olivier
AU - Biondi-Zoccai, Giuseppe
AU - Sabouret, Pierre
N1 - Publisher Copyright:
© 2023 by the authors.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - 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.
AB - 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.
KW - aged
KW - antithrombotic agents
KW - coronary artery disease
KW - frailty
KW - hemorrhage
KW - ischemia
KW - multimorbidity
UR - http://www.scopus.com/inward/record.url?scp=85169132219&partnerID=8YFLogxK
U2 - 10.3390/jcm12165233
DO - 10.3390/jcm12165233
M3 - Review article
C2 - 37629275
AN - SCOPUS:85169132219
SN - 2077-0383
VL - 12
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 16
M1 - 5233
ER -
