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Biomedical subjects

W S Aronow

Publications and source records attributed to W S Aronow.

At least 19 recordsLinked to original sources
PubMed1996

Risk factors for new atherothrombotic brain infarction in 664 older men and 1,488 older women.

The relation between obesity and new ABI is also unclear. The Framingham Study found that relative weight was not a risk factor for new ABI in older men but was a weak risk factor for new ABI in older women. Barrett-Connor and Khaw found no association between body mass index and new ABI in older men or women. The present study showed that obesity was not a risk factor for new ABI in older men. Obesity was a risk factor for new ABI in older women by univariate analysis but not by multivariate analysis. However, because obesity is associated with other risk factors for ABI and new coronary events, we would try to lower weight in obese older men and women.

Age Factors↗
PubMed1996

Risk factors for new coronary events in a large cohort of very elderly patients with and without coronary artery disease.

Independent risk factors for new coronary events in older men include age, prior coronary artery disease, cigarette smoking, systemic hypertension, diabetes mellitus, serum total cholesterol, and serum high-density lipoprotein cholesterol (inverse association). Independent risk factors for new coronary events in older women include age, prior coronary artery disease, cigarette smoking, systemic hypertension, diabetes mellitus, serum total cholesterol, serum high-density lipoprotein cholesterol (inverse association), and serum triglycerides (weak association).

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PubMed1996

Correlation of paroxysmal supraventricular tachycardia, atrial fibrillation, and sinus rhythm with incidences of new thromboembolic stroke in 1476 old-old patients.

The relationship between supraventricular tachycardia and the incidence of thromboembolic stroke has not been previously reported. We investigated in a prospective study the incidence of new thromboembolic stroke in 1476 patients, mean age 81 years, with atrial fibrillation, paroxysmal supraventricular tachycardia, or sinus rhythm detected by 24-hour ambulatory electrocardiograms. New thromboembolic stroke developed at 31-month follow-up in 87 of 201 patients (43%) with atrial fibrillation, at 43-month follow-up in 84 of 493 patients (17%) with paroxysmal supraventricular tachycardia, and at 45-month follow-up in 143 of 782 patients (18%) with sinus rhythm (p < 0.0001 comparing atrial fibrillation with paroxysmal supraventricular tachycardia or sinus rhythm). Kaplan-Meier survival curves showed a higher significance of thromboembolic stroke in patients with atrial fibrillation, compared to patients with paroxysmal supraventricular tachycardia or sinus rhythm (log-rank: p < 0.0001). Multivariate Cox regression model showed that independent significant predictors of thromboembolic stroke were: a) atrial fibrillation (relative risk = 3.31); b) prior thromboembolic stroke (relative risk = 2.85); c) sex (relative risk for women = 0.75); and d) age (relative risk = 1.02). These data show that atrial fibrillation is an independent predictor of thromboembolic stroke in elderly patients, and that paroxysmal supraventricular tachycardia is not associated with thromboembolic stroke.

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PubMed1996

Prevalence of atrial fibrillation and association of atrial fibrillation with prior and new thromboembolic stroke in older patients.

OBJECTIVE: To correlate atrial fibrillation with the incidence of new thromboembolic (TE) stroke in older patients with and without prior TE stroke. DESIGN: In a prospective study of 2101 older patients, electrocardiograms showed that atrial fibrillation was present in 283 patients (13%). At 42-month mean follow-up, atrial fibrillation was associated with the incidence of new TE stroke in patients with and without prior TE stroke. SETTING: A large long-term health care facility where 2101 older patients were studied. PATIENTS: The 2101 patients included 1451 women and 650 men, mean age 81 +/- 8 years (range 60 to 103). MEASUREMENTS AND MAIN RESULTS: Atrial fibrillation was present in 283 of 2101 patients (13%). The mean age was 84 +/- 7 years in patients with atrial fibrillation and 81 +/- 8 years in patients with sinus rhythm (P = .0001). The prevalence of atrial fibrillation was 5% in patients aged 60 to 70 years, 14% in patients aged 71 to 80 years, 13% in patients aged 81 to 90 years, and 22% in patients aged 91 to 103 years (P < .0001). Mean follow-up was 31 +/- 18 months in patients with atrial fibrillation and 44 +/- 27 months in patients with sinus rhythm (P = .0001). Previous TE stroke occurred in 123 of 283 patients (43%) with atrial fibrillation and in 431 of 1818 patients (24%) with sinus rhythm (P < .0001). New TE stroke occurred in 131 of 283 patients (46%) with atrial fibrillation and in 303 of 1818 patients (17%) with sinus rhythm (P < .0001). The log-rank test showed that patients with atrial fibrillation had a significantly higher probability of developing new TE stroke than those with sinus rhythm (P < .0001). The multivariate Cox regression model showed that independent risk factors for new TE stroke were male sex (relative risk = 1.3), prior TE stroke (relative risk = 3.1), and atrial fibrillation (relative risk = 3.3). CONCLUSIONS: Atrial fibrillation, prior TE stroke, and male sex are independent risk factors for the development of new TE stroke in older patients.

Age Factors↗
PubMed1996

Prevalence of appropriate and inappropriate indications for use of digoxin in older patients at the time of admission to a nursing home.

OBJECTIVE: To investigate the prevalence of digoxin use and appropriate and inappropriate indications for digoxin use in older patients at the time of admission to a nursing home. DESIGN: In a prospective study of 500 consecutive patients aged 60 years of age or older admitted to a nursing home, 96 (19%) patients were receiving digoxin at the time of admission to the nursing home. Appropriate and inappropriate indications for digoxin use were investigated in these 96 patients. SETTING: A large, long-term health care facility where 500 consecutive older patients were studied. PATIENTS: The 500 patients included 344 women and 156 men, mean age 81 +/- 8 years (range 60-100). MEASUREMENTS AND MAIN RESULTS: Ninety-six of the 500 patients (19%) were receiving digoxin at the time of admission to the nursing home. Fifty-one (53%) of the 96 patients receiving digoxin had an appropriate indication for digoxin use, and 45 (47%) had an inappropriate indication for digoxin use. Appropriate indications for digoxin use included atrial fibrillation with or without congestive heart failure (CHF) in 35 patients (36%) and CHF with sinus rhythm and abnormal left ventricular (LV) ejection fraction in 16 patients (17%). Inappropriate indications for digoxin used included CHF with sinus rhythm and normal LV ejection fraction in 18 patients (19%), misdiagnosis of edema or dyspnea as CHF in patients with sinus rhythm and normal LV ejection function in 17 patients (18%), history of possible (undocumented) paroxysmal atrial fibrillation in nine patients (9%), and sinus tachycardia in one patient (1%). Two of the 45 patients (5%) inappropriately treated with digoxin had evidence of digitalis toxicity on their admission electrocardiogram. CONCLUSIONS: The prevalence of digoxin use was 19% in older patients at the time of admission to the nursing home. Almost half of patients (47%) receiving digoxin at the time of admission had an inappropriate indication for digoxin use at that time.

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PubMed1996

Medical management of stable angina and unstable angina in the elderly with coronary artery disease.

Coronary artery disease is a major clinical problem in the elderly. This article discusses the medical management of stable and unstable angina pectoris. A review of the general measures and drug therapy used to treat these disorders, especially as they relate to the elderly patient are presented. In addition, new insights into the pathophysiologic mechanisms of chronic stable angina and unstable angina are reviewed.

Adrenergic beta-Antagonists↗
PubMed1996

Management of postmyocardial infarction in the elderly patient.

Elderly patients have a significantly higher mortality and morbidity compared with younger patients in the postmyocardial infarction period and thus, with the appropriate management have a greater potential for benefit compared with younger patients. It has been shown in the large randomized trials that elderly patients with acute myocardial infarction benefit significantly from administration of beta-blocking agents and angiotensin-converting enzyme inhibitors. Aspirin and warfarin sodium (Coumadin) have been shown to benefit patients of all age groups. Secondary prevention with cessation of smoking, use of lipid-lowering agents, treatment of hypertension, and estrogen therapy in the postmenopausal woman have been shown to be effective. Elderly patients, therefore, who are free of general noncardiac disability and who can be expected to live meaningful lives should be offered a comprehensive program to reduce their cardiac morbidity and mortality after discharge following acute myocardial infarction.

Adrenergic beta-Antagonists↗
PubMed1996

Smoking and coronary artery disease.

This article discusses the specific effects of smoking on the heart and coronary arteries and demonstrates how these effects increase the risk for cardiovascular morbidity and mortality. The conflicting results of various studies concerning the association of smoking and coronary heart disease in older persons are reviewed, and possible explanations for the discrepancy are given. Recent trends in smoking habits in the United States and the effects of these changing trends on cardiovascular mortality are presented. Finally, data are presented that demonstrate the effects of physician-directed cessation programs and the health benefits of smoking cessation in elderly and younger persons.

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PubMed1996

Clinical manifestations and diagnosis of coronary artery disease.

Coronary atherosclerosis is very common in the elderly population with autopsy studies demonstrating the prevalence to be at least 70% in persons over the age of 70. These autopsy findings may be coincidental, with the disease clinically silent throughout the person's life, although 20% to 30% of persons over age 65 years will demonstrate clinical manifestations of coronary heart disease (CHD). In most elderly persons, the disease will have manifested itself much earlier in their lives, however, in others the disease will be entirely silent until the person reaches his or her 70s or 80s. Unfortunately, even though CHD is prevalent in elderly persons, the disease is often not diagnosed or misdiagnosed in this age group. Failure to correctly diagnose the disease in the elderly may be due to the difference in the clinical manifestation in this age group compared with younger patients. Such differences may reflect a difference in the disease process between older and younger patients or it may be related to the superimposition of normal aging changes, plus the presence of concomitant diseases, which may mask the usual clinical manifestations.

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PubMed1995

Signal-averaged electrocardiography and ventricular tachycardia as predictors of mortality after acute myocardial infarction in elderly patients.

Signal-averaged electrocardiography and 24-hour ambulatory electrocardiographic monitoring were performed in 121 elderly patients > 6 months after acute myocardial infarction. All patients had asymptomatic complex ventricular arrhythmias and a left ventricular ejection fraction > or = 40%. Rates of sudden, cardiac, and total death were compared between groups with and without nonsustained ventricular tachycardia and between normal and abnormal signal-averaged electrocardiographic studies. The prevalence of an abnormal signal-averaged electrocardiographic study was 36%. Thirty-seven percent of the patients had nonsustained ventricular tachycardia, and the remaining patients had complex ventricular arrhythmias other than ventricular tachycardia. There were 27 sudden and 48 total cardiac deaths, and 66 deaths from all causes during a mean follow-up period of 30 months. Kaplan-Meier survival analysis showed a lower rate of sudden and cardiac death in the group without nonsustained ventricular tachycardia. Although there was a trend toward a lower rate of sudden death in patients with a normal signal-averaged electrocardiogram, there was no statistical difference in the rates of sudden, total cardiac, or total death between patients with normal or abnormal studies. The negative predictive value of having neither an abnormal signal-averaged electrocardiogram nor nonsustained ventricular tachycardia was 94% for sudden death. In elderly patients with complex ventricular arrhythmias and ejection fraction > or = 40% at least 6 months after an acute myocardial infarction, presence of nonsustained ventricular tachycardia predicted a higher rate of sudden and cardiac death. Signal-averaged electrocardiography alone was not predictive.

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PubMed1995

Left ventricular hypertrophy is more prevalent in patients with systemic hypertension with extracranial carotid arterial disease than in patients with systemic hypertension without extracranial carotid arterial disease.

The mechanism of the association between LV hypertrophy and ECAD is unknown and needs to be investigated. Whether LV hypertrophy in patients with systemic hypertension is a marker for ECAD or contributes to ECAD needs to be investigated. The association between LV hypertrophy and significant ECAD was independent of the level of blood pressure in our patients. Coronary atherosclerosis in our patients with signifciant ECAD may have contributed to the increased prevalence of LV hypertrophy. The association between LV hypertrophy and significant ECAD may contribute to the high incidence of stroke in patients with LV hypertrophy. This is currently under investigation by our group.

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PubMed1995

Usefulness of an abnormal signal-averaged electrocardiogram for predicting cardiac death in elderly persons without heart disease.

We found an abnormal signal-averaged ECG in 7 of 51 elderly patients (14%) (mean age 83 years) without clinical evidence of heart disease, and in 1 of 25 volunteers (4%) (mean age 31 years range [17 to 47]) without clinical evidence of heart disease. The data from our prospective study indicate that at 43-month mean follow-up, elderly patients with an abnormal signal-averaged ECG but no clinical evidence of heart disease do not have an increased incidence of sudden cardiac death, total cardiac death, or total death.

Age Factors↗
PubMed1995

Treatment of ventricular arrhythmias in older adults.

OBJECTIVE: To review the prognosis and management of ventricular arrhythmias (VA) in persons with and without heart disease with emphasis on older adults. DATA SOURCES: A computer-assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles. STUDY SELECTION: Studies on the prognosis and management of VA in persons with and without heart disease were screened for review. Studies in older people and recent studies were emphasized. DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving the older persons. Relevant articles were reviewed in depth. DATA SYNTHESIS: Available data about the prognosis and management of VA in persons with and without heart disease, with emphasis on studies involving older people, were summarized. CONCLUSIONS: VA in older persons without heart disease should not be treated with antiarrhythmic drugs. Class I antiarrhythmic drugs should not be used to treat VA in older persons with heart disease. Beta blockers should be used to treat complex VA in older persons with ischemic or nonischemic heart disease if there are no contraindications to beta blocker therapy. The use of amiodarone in treating complex VA should be reserved for life-threatening ventricular tachyarrhythmias in older persons who cannot tolerate or who do not respond to beta blockers. VA associated with congestive heart failure should be treated with angiotensin converting enzyme inhibitors. If older patients have life-threatening recurrent ventricular tachycardia or ventricular fibrillation resistant to antiarrhythmic drugs, invasive intervention should be performed. The automatic implantable cardioverter-defibrillator is recommended in older patients who have medically refractory sustained ventricular tachycardia or ventricular fibrillation.

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