Anita W. Asgar, MD, FRCPC, Interventional Cardiology Fellow, Montreal Heart Institute, Montreal, QC.
Renee L. Schiff, MD, FRCPC, Echocardiography Fellow, Montreal Heart Institute, Montreal, QC.
Reda Ibrahim, MD, CSPQ, FRCPC, Interventional Cardiologist, Montreal Heart Institute, Associate Professor of Medicine, Universite de Montreal, Montreal, QC.

Hypertension is a common health concern among older adults and constitutes an important risk factor for cardiovascular disease. Despite its prevalence, it is a constant management challenge. We review four aspects of hypertension management that have been of interest over the past year.
Key words: hypertension, diabetes, drug therapy, gender differences, resistant hypertension.

Adrienne H. Kovacs, PhD, CPsych, Behaviour Cardiology, Division of Cardiology, University Health Network, Toronto, ON.

Approximately 20% of older adults with cardiovascular disease (CVD) experience significant depression. Further, in a pattern consistent with the general adult population, women with CVD have double the rates of depression compared to men. Among older men and women with CVD, depression is associated with poorer cardiac outcomes, although patterns of depressive symptoms appear to differ between men and women. Treatment approaches include traditional modalities, namely psychotherapy and pharmacotherapy. Additional recommendations involve emphasizing adherence to prescribed medical and behavioural health regimens, fostering social support, and increasing referrals to cardiac rehabilitation programs as medically appropriate.
Key words: depression, gender differences, cardiovascular disease, myocardial infarction, mortality.

I am writing this editorial just three days after attending an extraordinary event sponsored by the University of Toronto Department of Medicine. This event was a celebration of the promotion to full professor of three extraordinary women: Drs. Paula Rochon, Gillian Hawker, and Judith Miller. Although the promotions were based on the individual excellence of the three candidates, the event was also a testament to the equality of opportunity women have finally achieved in academia after so much effort (government and business should strive to be so egalitarian). Even more importantly, some of the work these three scientists have produced is germane to the topic of this month’s journal, specifically the answers to the question “Are women different from men?” These types of questions are important to answer if we hope to provide the best of medical care to both men and women. Although numerous areas of difference in disease epidemiology, presentation, and management occur, this issue looks specifically at the largest cause of morbidity and mortality among older adults: cardiac disease.

Our CME article this month, “Gender and Coronary Heart Disease in Older Adults” by Drs. Arlene Bierman and Nahid Azad, addresses our theme head-on. The theme also runs through many of the other cardiac articles appearing in these pages. The article “Cardiovascular Imaging and Noninvasive Diagnosis for Older Adults” is by Drs. Sherryn Rambihar and Beth Abramson. Dr. Abramson is one of Canada’s best-known investigators in the area of differences between men and women in cardiac disease. Dr. Adrienne Kovacs discusses the topic of “Cardiovascular Disease and Depression in Older Men and Women,” an area of concern not only in regard to diagnosis and treatment, but in regard to prognosis as well. Our regular CVD column this month is a continuation from last issue, “Prosthetic Heart Valves, Part II: Clinical Management,” by Dr. Jagdish Butany, Nasir A. Khan, Sarah A. Erlich, Dr. Anusha Jegatheeswaran, Dr. Frances Budden, and Dr. Vivek Rao. Even our regular dementia column this month is linked to cardiac disease. Elise Levinoff, MSc, discusses “Vascular Dementia and Alzheimer’s Disease: Diagnosis and Risk Factors,” which is common in people with cardiac disease. Ms. Levinoff’s research, done while obtaining a master’s degree in neuroscience, interested her so much in clinical medicine that she is now completing her MD degree at the University of Ottawa.

Our other articles this month are also of great interest. Drs. Louise Provencher and Julie Lemieux provide an “Update on Endocrine Therapy for Postmenopausal Women with Early Breast Cancer,” while Drs. Cinzia Maraldi and Marco Pahor review the common, yet at times very difficult, topic of “The Impact of Anemia on Physical Function among Older Adults.” Finally, our Editorial Director, Kristin Casady, reviews research recently published on the efficacy of fall prevention programs.

Enjoy this issue,
Barry Goldlist