Editors: Wilbert S. Aronow, Jerome L. Fleg, Eds.
Publisher: Marcel Dekker, Inc., 2003
Reviewed by: Jagdish Butany, MBBS, MS, FRCPC, Consultant Cardiovascular Pathologist/Director Autopsy Services; Co-Editor-in-Chief, Cardiovascular Pathology; Professor, University of Toronto; Director, Division of Pathology, Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, Toronto, ON.
This third edition of Cardiovascular Disease in the Elderly reflects well and in detail the age-related changes in cardiovascular disease, as well as its presentation, diagnosis, and management. Cardiovascular disease represents an increasing and important cause of morbidity and mortality in middle and even more so in old age, accounting for nearly half (if not more) of all adult deaths. The chapter subjects in this book reflect the wide spectrum of the aspects of cardiovascular disease that the individuals who deal with cardiovascular disease in older adults need to be familiar with. The topics are well chosen and the authors of each chapter offer good details regarding them.
The materials covering the cardiovascular system are well divided into numerous sections, each of which appears to be well addressed and covered. Many of the sections are significant in detail, something that should serve as a good resource for anyone dealing with cardiovascular disease in older adults. It is difficult to imagine anyone who, given the changing demographics in countries, will not have to deal with them in some stage or another.
Some chapters are of particular interest, as they are not often covered well in any books. Amongst these are the chapters on peripheral vascular disease in older adults. Given the significance of peripheral vascular disease in this patient group, the introduction to the condition, discussion of the causes, and then the detailed discussion of abdominal aortic aneurysms, thoracic abdominal aneurysm, mesenteric ischemia, and renovascular disease are well done. The discussion of smaller vessels, that is, lower extremity arterial disease, is slightly less detailed.
The section on medical management of peripheral vascular disease and the discussion of reconstruction gives good insight into the options available. The discussion of the need for amputations in people with peripheral arterial disease is appropriate and should give the reader current information with regard to options, even though amputation may be considered a last resort. The discussion of percutaneous transluminal angioplasty is good, though given the rapidly changing nature of materials of which stents are made and designed it may already be slightly dated.
Each section appears to have a good number of references, which should be of help to the individuals interested in more detailed information.
The section on the pathophysiology of coronary artery disease, that is, the basis of the understanding and management of coronary artery disease, is written by experts in the field and is well done. The slightly surprising feature is the good deal of detail offered so that even a rapid review of this chapter would help the reader understand the basis of its genesis and management.
Very appropriate for a book of this kind dealing with patients of this age group is the final chapter on “Ethical Decisions and the Quality of Life in Older Patients with Cardiovascular Disease.” This section is dealt with well and appropriately and since, as the authors begin this section with, “Death is the only certainty in life,” it is essential that anyone dealing with older adult patients be conversant with it. Some of the comments in this section are very appropriate and ones that many physicians need to take to heart (no pun intended). The section also discusses Do Not Resuscitate orders and offers a brief update on euthanasia and the “Oregon Death with Dignity Act.” In short, this book provides a good and detailed overview of the genesis, investigation, and diagnosis of cardiovascular disease in older adults. It provides a very welcome edition (an updated version of the previous edition) for every practicing physician who deals with older adults.
