Glycoprotein IIb/IIIa Inhibitors in the Elderly

In Western countries, persons 75 years of age or older constitute ≈5% of the population but account for more than one third of those with acute coronary syndromes. In addition, one third of this elderly population has exercise-induced silent ischemia. The elderly population is projected to be more than 3 times larger in 2050 as today. The lower fertility rate and reduced mortality account for the aging of global population now and during the coming 50 years.1 However, this problem is not a problem for the richest countries only, and, according to the World Health Organization, the developing countries are actually more vulnerable to cardiovascular diseases, which have increased by more than 120% in the last 30 years compared with a 50% increase in developed countries over the same period. Better information and education of the elderly population, better access to healthcare services, earlier detection of coronary artery disease, better quality of care delivered to the elderly, and extrapolation to older persons of modern, evidence-based medicine, and often of modern aggressive care successfully tested in younger populations, are leading to dramatic changes in the management of this segment of the population. The painful consequence is that health systems will be stretched as the number of elderly patients increases. There will be a need for more investment in treatments of coronary artery disease, development of more aggressive prevention, and evaluation of the best cost-effective measures in this group of patients.Article p 2040 Most randomized, clinical trials have enrolled few older persons, and, as a result, fewer data are available to firmly guide clinical practice. Despite a distinct profile with more frequent comorbidities, a limited life expectancy, reductions in volume of distribution, hepatic, and renal functions, as well as pathophysiological changes that affect dosing, efficacy, and toxicity of drugs, several …