Coronary Artery Disease

In recent editorials, I have commented on the importance of dementing disorders, the fact that arthritis is the major issue affecting older adults’ quality of life, and the growing burden of cancer as our society ages. I might have seemed to forget the importance of cardiovascular diseases, but in fact cardiovascular disease is never far from the mind of doctors caring for older adults. At times it seems universal in our patients. As cardiologists become more and more involved in invasive procedures and sophisticated diagnostic testing, it seems that ever more of the burden of the actual day-to-day care of these patients is returning to the hands of family physicians (and, at times, general internists and geriatricians). Congestive heart failure remains the commonest reason for hospital admission in North America, and the disorder affects predominantly older adults. We hope that this edition of Geriatrics & Aging will help you care for patients with cardiac disease.

Family doctors provide almost all the care for patients after they suffer an acute cardiac event, and proper care to prevent recurrences is one of their most important jobs. This area is explored in the CME article “Secondary Prevention in Coronary Artery Disease” by Tanya M. Holloway, Lisa Kwok, Margaret Brum, and Dr. Caroline Chessex. In the early 1990s there was a bitter debate in the medical community, much of it published in the CMAJ, about the role of screening for, and then treating, dyslipidemias. We now have much better evidence on which to base our actions, and this is reviewed in the article “Lipid Management--Who to Screen? Who to Treat?’ by Dr. David Fitchett. Part of secondary prevention is dietary advice, and the article “Popular Diets and Coronary Artery Disease” by Drs. C. Tissa Kappagoda and Dianne A. Hyson will help family doctors answer their patients’ queries.

As well, we have our usual group of columns and articles of general interest. Our movement disorders article is “Pharmacologic Options in Parkinson’s Disease: A Treatment Guide” by Drs. Steven E. Lo and Steven J. Frucht. Our Drugs & Aging column is entitled “Aging and the Neurobiology of Addiction” by Drs. Paul J. Christo, Greg Hobelmann, and Amit Sharma. Our ophthalmology article is on a very important topic, “Medical Management of Glaucoma: Clinical and Research Update” by Drs. Elliott M. Kanner and James C. Tsai. Dr. Roger Wong considers the “Assessment of Mobility Impairment” in our Biology of Aging column. The Caregiving column, “Ethnic Differences in the Caregiving Experience: Implications for Interventions,” by Drs. Martin Pinquart and Silvia Sörensen is very important in a multicultural society such as ours.

Our final two columns are related to our focus on cardiovascular disease. The technology in medicine article is on “Syncope in the Older Adult: When Is a Pacemaker Indicated?” and is written by Dr. Gabriel Gregoratos. Our cardiovascular column is on that most common of disorders that doctors manage: hypertension. It is entitled “Hypertension in the Older Adult: An Update on Canadian Hypertension Education Program Recommendations” and is by Drs. Norm R.C. Campbell, J. George Fodor, Robert Herman, and Pavel Hamet.

Enjoy this issue, and best wishes for the season.

Barry Goldlist