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Melanie Cole (Host):  An estimated 83 million American adults, one in three, have one or more types of cardiovascular disease.  Of these, 42 million are estimated to be over the age of 60.  My guest today is Dr. Peter Vaitkevicius.  He’s a cardiologist with Aspirus Keweenaw and Aspirus Ontonagon Hospitals.  Welcome to the show, Dr. V.  So, tell us about what’s going on with cardiovascular disease and our older population.

Dr. Peter Vaitkevicius (Guest):   Well, as you mentioned, the older population are the ones that have the most frequent and most severe forms of cardiovascular disease.  I think the biggest thing that we have to do in the older population is to determine what is the best therapy for them.  There are many things that we can do to grandma with regards to interventions and things of that sort.  The big question for me has been, what’s the most appropriate thing to do for her that’s going to make her more functional, more capable and more resilient to her disease.

Melanie:  Is it a rite of passage, as it were, to develop cardiovascular disease as you get older or not necessarily?

Dr. Vaitkevicius:  Well, it’s certainly something we can limit.  With the aging process, there’s a reduction of muscle mass, there’s a reduction in heart function, there’s a reduction of the vascular tree.  All these things kind of add up to make the patient more symptomatic.  Then, if you have the patient that develops coronary disease or some sort of injury to the heart muscle, those symptoms are worse in the older population compared to the younger population.  Being physically fit, avoiding that first heart attack, avoiding any blood pressure issues, avoiding diabetes are certainly things that we can do to mitigate the effects of aging on the cardiovascular system.

Melanie:  Are there certain screenings you would like the older population to be going through on a regular basis so you can catch any of this early and possibly use interventions?

Dr. Vaitkevicius:  By far and away, the most important thing is to screen them carefully for hypertension.  Hypertension in older populations can be insidious, it can be substantial and it can also be associated with cataclysmic clinical presentations.  So, I think screening the older populations for blood pressure regulation and blood pressure control is very, very important.  The other thing is to make sure people stay healthy with regard to other co-morbidities that they might have such as diabetes, such as pulmonary lung disease.  A comprehensive review of the patient’s basic medical problems should be done on a regular basis. 

Melanie:  What about our older folks that do have some sort of cardiovascular disease?  So many millions of Americans, Dr. V, have high blood pressure, as you mentioned.  Do you think that they are adhering to their medications?  Is this controlled or is this one of our bigger problems that we’re seeing and we need to work on getting them to adhere to their regimens?

Dr. Vaitkevicius:  I think most people have to realize that when they are diagnosed with hypertension, it’s usually a lifelong condition.  These medications will be taken for an extended period of time.  The medications that we have now don’t necessarily cure the hypertension or make it go away to the point that we don’t have to take medications. These medications primarily control the severity of the disease.  So, once you’re diagnosed with hypertension, regardless of age, it’s really kind of a long commitment. You need with comprehensive care.  So, keeping the patient involved in the game, keeping the patient’s head in the game and making sure they realize how important it is to take the medications is very substantial.  The other thing that complicates the older patient is they have conditions, like diabetes. So, the older patient is on multiple medications oftentimes 4, 5, 6, 7, 8, 9 different drugs for the control of their various co-morbidities.  It takes a little bit of craftiness to adjust the medications so all of these conditions don’t interact and so the medication for diabetes doesn’t worsen the heart failure episode or the medication for hypertension doesn’t cause low blood pressure or slow heart rate that makes cause a patient to be symptomatic.

Melanie:  Dr. V, as much as we would like our older folks to be active and move around, as you speak of co-morbidities, they also have physical limitations that sometimes limit their ability to be as active as we might like - rheumatoid arthritis and osteoarthritis and all of these other things.  Where do those fit in to the activity level we would like them to do so that they can, hopefully, prevent some of these cardiovascular diseases from continuing to get worse?

Dr. Vaitkevicius:  Most older patients with various cardiac diseases can participate in training programs, exercise programs and that activity to maintain the integrity of the skeletal muscle and joint strength is very, very important and can often mitigate or reduce the symptoms associated with coronary disease or heart failure.  I think it’s very, very important to encourage the older patient to remain active.  It may be a different type of activity – gradual walking exercise that’s done carefully in the shopping mall as opposed to going to the gym--but each patient must have a regimen, a schedule, a desire to participate in physical activity and oftentimes it is a great way to reduce symptoms of heart disease.

Melanie:  As we look at our older population, people are always asking me, Dr. V, “Is it considered a family risk, a genetic risk, if your parents developed heart disease after, say, the age of 75 or 80?”  Or, do we not look at that as a familial risk at this point?

Dr. Vaitkevicius:  We still look at it as a risk.  The premature coronary disease, heart attacks  that may occur in the males before the age of 50, or after the age of 50 and in females after the age of 60, those are really strong predictors of an early atherosclerotic disease, early cardiac events.  But, even as we get older having a family history of hypertension still implies risk for that in someone else in the family.  So, those factors still need to be controlled and adjusted for and watched for.

Melanie:  What do you want these caregivers to know, if we’re in that sandwiched generation and you’re taking care of older parents or older relatives or you’re a caregiver for someone, if someone does have cardiovascular disease, what’s the most important bit of information you want them to know about taking care of themselves?

Dr. Vaitkevicius:  Well, the most important thing is that one, to focus on their health and well-being.  Take time, set time aside to do the physical training that they need to do to stay healthy.  Budget that time and actually change your schedule a little bit to allow physical activity and comprehensive care.  The other thing is to realize that these medication regimens can be very complicated.  You may have to be very patient with the older patient and encourage them to slowly titrate medications in one direction up or one direction down.  It’s often very important to work with them on a daily basis or a weekly basis and having physicians or care providers or nurses who can stop by and adjust the medication on a once a month basis or a once every two week basis.  There are often ways to tend to promote doses that will optimize the benefit of the medications.  So, sitting down and working with these patients on a casual basis, on a regular basis, is very important.

Melanie:  Where does cholesterol fit in?  We hear so much about it and the medications can actually have side effects that older people are afraid of or a pain here and there.  What do you tell them about controlling their cholesterol at that age?

Dr. Vaitkevicius:  There are certain ages where the data isn’t as robust but certainly the statin medications are one of the significant medications that are given in cardiovascular disease to reduce the risk for further events, both heart attack and strokes.  I think it’s very important that we can discuss these medications with the older patients but be mindful that there is certainly some age where the benefits of these medications might be limited.  The side effect profiles, for the most part, you can usually find a statin-like medication that a patient can manage, the patient can take.  It may take a little bit of time, you may have to expose the patient to different medications and different ways of giving the medication to reduce the symptoms but cholesterol management and the statin medications I still think play a very important role in the population of 70 and above.

Melanie:  In just the last few minutes, Dr. V, your best advice for those patients 70 and above in regards to cardiovascular disease and why they should come to Aspirus for their care.

Dr. Vaitkevicius:  I think Aspirus is focused on the totality of the patient.  We integrate very well our specialists, our cardiovascular specialists and our primary care physicians.  I think it’s important in this population to have somebody who can manage all the diseases together and when something is required--an intervention is required--that the most appropriate care is provided to the patient.  I think that’s something we do very well at Aspirus.

Melanie:  Think you so much.  It’s really great information.  You’re listening to Aspirus Health Talk and for more information you can go to Aspirus.org.  That’s Aspirus.org.  This is Melanie Cole.  Thanks so much for listening.