Over 65? Focus on Heart Health

More than 60% of cardiology patients are over age 65. 

At this stage in life, managing your heart health is more important than ever. As you age, your blood pressure and cholesterol can rise, increasing your risk for heart attack and stroke. With age, your body also changes how it metabolizes drugs, which can cause over- or under-medicating. 

These changes to your heart health are often called “silent killers” because they can develop slowly with few symptoms. It’s essential to speak to your doctor about your risk factors, medications, and lifestyle to protect yourself from advancing heart disease and other life-threatening heart conditions.

“Age alone is not usually a reason to avoid aggressive treatment,” says Murry Drescher, M.D., a cardiologist with the University of Miami Health System. He specializes in best practices for older adult patients and manages treatment to improve the quality of life for patients and caregivers. 

“It’s up to your physician to outline the options, risks, and benefits of your treatment plan. The decision as to how aggressively you should be treated involves an extensive conversation with your family before you begin or continue treatment.”

If you are over 65, keep an eye on your blood pressure and cholesterol numbers, commit to certain diet and lifestyle choices that support your heart health, and discuss the following risk factors with your doctor, Dr. Drescher says. 

Are you taking multiple medications?

“Many older heart patients have other coexisting illnesses that complicate their treatment. Because of multiple illnesses, you may take more than five daily medications,” Dr. Drescher says. “As the number of medications increases, so does the risk of side effects. Your physician should discuss potential side effects and alternatives with you.” 

Some medications cause more side effects in older adults. When you start a new prescription, you should check in with your doctor every month to assess its efficacy and side effects in combination with your other medications. In certain cases, taking multiple medications that work differently and at lower doses can potentially reduce or eliminate side effects.

“Your tolerance for certain medications can change, even if you’ve been taking them for many years and tolerated them well,” Dr. Drescher says. “Medications for prostate and hypertension, for instance, can cause fainting in older patients who had been taking the medications for years without problems.” 

To manage high cholesterol, you may be taking a statin drug. “The most common side effect of statins is muscle aches, which are often difficult to distinguish from pains that occur more frequently in older people,” Dr. Drescher says. If statins are giving you side effects, speak to your doctor about injectable cholesterol medications.

Do you monitor your blood pressure?

The goal for blood pressure control in adults over 65 is the same for younger adults: systolic blood pressure should be 130 or lower, and diastolic pressure should be 80 or lower. 

“As you age, your arteries stiffen, which can cause isolated systolic hypertension (high blood pressure),” says Dr. Drescher. “We used to think it was normal for older patients to develop high blood pressure and have more heart attacks and strokes. But, treating hypertension in older adults effectively reduces their risk for heart attack, stroke, and death.” 

Don’t accept high blood pressure and the risks associated with it as an unavoidable part of aging. Significantly low blood pressure can trigger dizziness, falls, and fainting. Both of these conditions should be addressed by your doctor.

How’s your cholesterol?

“In older people, high cholesterol should be treated if you have vascular disease, a condition where plaque builds in the coronary arteries, great vessels, carotid arteries, and leg arteries,” says Dr. Drescher. “In older patients without vascular disease, treatments to reduce cholesterol significantly do not decrease the risk of heart attack and stroke.”

Speak to your doctor about your latest fasting cholesterol test to learn more about your cholesterol numbers.

Does heart disease run in your family?

If you have stable coronary heart disease, you may experience chest pain with exertion, but it goes away with rest. “Your treatment depends on whether your symptoms can be controlled with medication and if your stress test or echocardiogram show evidence of high risk,” Dr. Drescher says. “Stable coronary artery disease requires aggressive risk management, including lowering cholesterol and controlling blood pressure.” 

Have you spoken to your doctor about AFib?

Your risk for developing atrial fibrillation (AFib) increases with age. This irregular heart rhythm can lead to blood clots and strokes. 

The treatment of AFib focuses on controlling the rapid heart rate with the goal of restoring a normal rhythm. “In the elderly, there is increased risk of bleeding,” Dr. Drescher says. “Frail patients may not be able to take the blood-thinning, anticoagulation medications prescribed to treat AFib.”

If you or a loved one are managing AFib with a risk for serious bleeding, talk to your doctor about other, safer therapies.

Can you avoid heart failure?

Aortic stenosis is most often a disease that impacts the heart health of people over 65. This disease develops calcium deposits on the aortic valve, preventing it from fully opening, which can lead to heart failure and death. 

Dr. Drescher says, “Aortic stenosis can now be safely treated—even in very elderly patients—with a bio- prosthetic aortic valve implant. We place this implant through an artery in the leg or via minimally invasive surgery.” 

Take your cardiovascular health to heart.

Beyond taking your heart medications as prescribed, you can reduce your risk for heart disease, stroke, and heart attack with some heart healthy lifestyle choices. 

Most importantly, maintain a healthy weight. It’s not too late to enjoy a heart-smart diet and exercise regularly (cardio, strengthening, and stretching). Reduce how much alcohol you drink, finally quit smoking, get more quality sleep, and lower your stress.

Along with medical treatment, these lifestyle changes can improve your quality of life, increase your energy, and reduce your risk for heart attack, heart failure, and premature death.

To make an appointment with Dr. Drescher, click here.

Dana Kantrowitz is a contributing writer for UMiami Health News.

Tags: Afib, Dr. Murry Drescher, geriatrics, heart care in Miami