B-Type – ABC CARDIOL

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Editorial

What to Expect from Cardiovascular Life at 85?

While there is plenty of literature for risk prediction of cardiovascular disease and preventive therapies, risk estimates are less well known for patients aged > 80 years. There is a need to address this gap in knowledge, as the health status of very elderly people will increasingly impact on health care.

A detailed study carried out in Beijing by Zhu et al., published in this journal, describes the 5-year risk of cardiovascular disease in 724 very elderly Chinese patients – all > 80 years old, most of them men. They were admitted to the geriatric cardiology department, something that is an evolving field at the international level. The reasons for hospital admission were mostly related to coronary artery disease and hypertension control; only a few were admitted for respiratory or digestive tract disease. After a median follow-up of 5.3 years and a follow-up rate of 98%, about 50% of the patients died, most of them from infections and only 1 in 16 patients from a cardiac cause. The study shows that cardiovascular morbidity and all-cause mortality risk in this population can be successfully predicted by the N-terminal pro-B-type natriuretic peptide levels (NT-proBNP).

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Artigo Original

ACE inhibitors and plasma B-type natriuretic peptide levels in elderly patients with heart failure

Felicio Savioli Neto et al. Hélio M. Magalhães Michel Batlouni Leopoldo S. Piegas

BACKGROUND: Clinical trials have demonstrated the benefits of ACE inhibitors (ACEI) in the neurohormonal activity and in the functional capacity of patients with heart failure (HF), and also that these effects are dose dependent. However, since elderly individuals have been systematically excluded from the majority of these studies, the validation and incorporation of these results in the geriatric population has been questioned. OBJECTIVE: To evaluate the effects of different doses of quinapril, an ACEI with a > 24-hour biological half-life, on plasma BNP levels, on the distance walked in the 6-minute walk test (6MWT) and on the incidence of adverse reactions in elderly individuals with systolic HF. METHODS: A total of 30 patients (76.1 ± 5.3 years; 15 women), in NYHA functional class II-III HF, with left ventricular EF < 40% (33.5 ± 4.5%), on diuretics (30), digoxin (24) and nitrates (13) were included. The patients were assessed at baseline and every two months, with escalating doses of quinapril of 10, 20, 30 and 40 mg. RESULTS: After eight months, BNP levels were 67.4% lower and the distance walked in the 6MWT was 64.9% longer in relation to baseline. Arterial hypotension with symptoms of low cerebral blood flow and/or renal dysfunction was not observed, so that the maximum quinapril dose could be used in all patients. CONCLUSION: The results demonstrated the benefits of ACEI on the neurohormonal profile and functional capacity of elderly individuals with systolic HF, as well as the positive relationship between dose and effect of these drugs.

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What to Expect from Cardiovascular Life at 85?

ACE inhibitors and plasma B-type natriuretic peptide levels in elderly patients with heart failure

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