Combined Exercise Training Performed by Elderly Women Reduces Redox Indexes and Proinflammatory Cytokines Related to Atherogenesis.

Cardiovascular benefits for the general population of combined aerobic-resistance exercise training are well-known, but the impact of this exercise training modality on the plasma lipid, inflammatory, and antioxidant status in elderly women that are exposed to a great risk of developing ischemic cardio- and cerebrovascular diseases has not been well investigated. So, we aimed to evaluate the plasma lipids, oxidative stress, and inflammatory cytokines in 27 elderly women (TRAINED group, 69.1 ± 8.1 yrs) that were performing moderate intensity combined aerobic-resistance exercise training (3 times/week for at least 18 months) and in 27 sedentary elderly women (SED group, 72.0 ± 6.4 yrs), not submitted to exercise training for at least 5 yrs. Our results showed that BMI was lower in the TRAINED group than in the SED group (25.1 ± 3.2 vs. 28.7 ± 5.1, p < 0.05). The TRAINED group had lower glycemia (92 ± 3 vs. 118 ± 12, p < 0.05), glycated hemoglobin (5.9 ± 0.1 vs. 6.4 ± 0.2, p < 0.05), and triglycerides (98 (75-122) vs. 139 (109-214), p < 0.01); equal total cholesterol (199 (175-230) vs. 194 (165-220)), LDL-cholesterol (108 (83-133) vs. 109 (98-136)), and non-HDL-cholesterol (54 (30-74) vs. 62 (26-80)); and also higher HDL-cholesterol (64 (52-77) vs. 52 (44-63), p < 0.01) and LDL-C/oxLDL ratio (13378 ± 2570 vs. 11639 ± 3113, p < 0.05) compared to the SED group. Proinflammatory cytokines as IL-1ß (11.31 ± 2.4 vs. 28.01 ± 4.7, p < 0.05), IL-6 (26.25 ± 7.4 vs. 49.41 ± 17.8, p < 0.05), and TNF-α (25.72 ± 2.8 vs. 51.73 ± 4.2, p < 0.05) were lower in the TRAINED group than in the SED group. The TRAINED group had lower total peroxides (26.3 ± 7.4 vs. 49.0 ± 17.8, p < 0.05) and oxidized LDL (1551 ± 50.33 vs. 1773 ± 74, p < 0.02) and higher total antioxidant capacity (26.25 ± 7.4 vs. 49.41 ± 17.8, p < 0.001) compared to the SED group. In conclusion, in TRAINED women, BMI was lower, plasma lipid profile was better, plasma oxidative stress was diminished, and there was less expression of proinflammatory interleukins than in SED, suggesting that combined aerobic-resistance exercise training may promote the protection against the complications of ischemic cardio- and cerebrovascular disease in elderly women.

Dyslipidemia: evidence of efficacy of the pharmacological and non-pharmacological treatment in the elderly.

THE CLINICAL DECISION TO CONTROL RISK FACTORS FOR CARDIOVASCULAR DISEASE (CVD) IN THE ELDERLY TAKES THE FOLLOWINGS INTO CONSIDERATION: (1) the elderly life expectancy; (2) the elderly biological age and functional capacity; (3) the role of cardiovascular disease in the elderly group; (4) the prevalence of risk factors in the elderly; and (5) The effectiveness of treatment of risk factors in the elderly. A large number of studies showed the efficacy of secondary and primary prevention of dyslipidemia in the elderly. However, the only trial that included patients over 80 years was the Heart Protection Study (HPS). Statins are considered the first line therapy for lowering low-density lipoprotein cholesterol (LDL-C). Because lifestyle changes are very difficult to achieve, doctors in general tend to prescribe many drugs to control cardiovascular risk factors. However, healthy food consumption remains a cornerstone in primary and secondary cardiovascular prevention and should be implemented by everyone.

Peculiaridades da farmacoterapêutica cardiovascular no idoso / Peculiarities of the cardiovascular pharmacotherapeutic in the elderly

O incremento da população geriátrica representa importante alteração demográfica do final do século XX e início do XXI. Como um grupo, idosos requerem cuidados médicos e terapêuticos mais freqüentes e utilizam o serviço de saúde em maior escala que indivíduos mais jovens. Essa revolução demográfica tem importantes implicações práticas, diagnósticas e terapêuticas. A utilização apropriada de medicamentos na população geriátrica requer o conhecimento das alterações fisiológicas do envelhecimento e dos efeitos das doenças concomitantes, que podem influenciar a farmacocinética e a farmacodinâmica, assim como das respostas terapêutica e tóxica aos medicamentos, de forma clinicamente importante. A falta de atenção cuidadosa na seleção, na posologia e na monitoração dos fármacos nessa população pode induzir benefício terapêutico incompleto e alta incidência de reações adversas. Isso é particularmente significante para os medicamentos cardiovasculares, muitos dos quais têm índice tóxico/terapêutico estreito. Como as idades cronológica e biológica freqüentemente não são comparáveis, e como existem grandes variações entre os idosos nas respostas farmacocinética e farmacodinâmica, é difícil estabelecer generalizações. Fatores socioeconômicos e a não-observância adequada da prescrição são causa importante da falha terapêutica em qualquer idade, e particularmente nos idosos. Polifarmácia, esquemas terapêuticos complicados, distúrbios visuais, auditivos ou mentais, falta de compreensão, ausência de auxílio de familiares ou afins são alguns dos muitos fatores que contribuem para a não-observância ao tratamento.

The increase of the geriatric population represents a major demographic change in the end of the 20th Century and beginning of the 21st. As a group, the elderly require a closer and more frequent medical and therapeutic care and use health services in a larger scale than younger individuals. Such demographic revolution comprehends major practical, diagnostic and therapeutic implications. The appropriate use of medication in the geriatric population requires knowledge on the physiologic changing of the aging and on the effects of the collateral diseases that may impact on the pharmacokinetics and pharmacodynamics, the therapeutic and toxic response to medication, in a substantial clinical way. The lack of careful attention in the selection, posology and monitoring of the pharmaceutical drugs in this population may incite an incomplete therapeutic benefit and a high occurrence of conflicting reactions. This is particularly meaningful in the case of cardiovascular medication, many of which have a very critical toxic/therapeutic rate. Since the chronologic and biologic ages are usually not comparable, and since there are great variation among the elderly in the harmacokinetics and pharmacodynamics responses, it is difficult to establish generalization. Social and economical factors as well as the non-observance of adequate prescription are major reasons for therapeutic failure in any age, and particularly with the elderly. Polypharmacy, complicated therapeutic schemes, visual, hearing or mental impairment, lack of comprehension, absence of assistance from family members or relatives, are some of the many factors that contribute for non-observance of treatment.

Tratamento não-medicamentoso da hipertensão no idoso / Non-pharmacological treatment of hypertension in the elderly

O tratamento não-farmacológico da hipertensão arterial no idoso é realizado por meio de mudanças no estilo de vida. Essas mudanças podem prevenir ou retardar a instalação de hipertensão em idosos pré-hipertensos e reduzir níveis pressóricos elevados em idosos hipertensos. Entretanto, mudanças do comportamento habitual adquirido ao longo da vida não são facilmente realizadas, pois exigem disciplina e paciência para obter resultados. Além disso, é necessário que o idoso receba orientação e conscientização da importância do controle desses fatores para que se motive a executar tais mudanças comportamentais.As principais modificações no estilo de vida que podem reduzir a pressão arterial são: a prática de atividade física e a mudança de hábitos nutricionais. A atividade física deve ser de fácil realização, com exercícios de curta duração e baixa intensidade, visando desenvolver a resistência, flexibilidade articular e força muscular sem provocar lesões, e pode ser fracionada ao longo do dia, com aumento gradativo do tempo e da intensidade do exercício. Os hábitos nutricionais devem visar à redução c de sódio e ao controle de peso. A pressão arterial aumenta progressivamente à medida que o índice de massa corporal aumenta. O idoso obeso ou com sobrepeso se beneficiará com a redução de peso tanto quanto o jovem. Recomenda-se um programa de redução de peso que E inclua atividade física e restrição de calorias para idosos com 10 acima de seu peso ideal, além de redução do sal da dieta para 2,4 g de sódio ou 6 g de cloreto de sódio (correspondente a uma colher de chá).

Implantable cardioverter-defibrillators: expectations in the Brazilian elderly.

By 2025, Brazil will have the sixth largest elderly population in the world. Thirty percent of the elderly currently have private health insurance and 70% have their health care paid for by the Unified Health System. The system, founded through a governmental entity, provides free health service to all citizens. In 2003, the government passed the Elderly Statement Law, claiming that the elderly have equal access to prevention, promotion, protection, and recovery of health. In spite of the high costs, the placement of implantable cardioverter-defibrillators (ICDs) in the elderly is growing. There is a significant regional difference in the number of ICD placements, and there is also a significant sex bias: 73% of the ICDs were placed in elderly men. The majority of ICDs were placed in the elderly from ages 65 to 79 years. Nevertheless, 9.5% of ICDs were placed in octogenarians and nonagenarians, reflecting the valuation of biologic age rather than chronologic age.

Influence of age and coronary artery disease on homocysteine levels in the young old compared with the old old and the oldest old.

A total of 172 elderly individuals, divided into case and control groups based on the diagnosis of coronary artery disease, underwent coronary angiography to investigate the influence of age and coronary artery disease on homocysteine levels. The subjects were divided into three age ranges: 65-74 years, 75-79 years, and 80 years and older. Continuous homocysteinemia was associated with a risk ratio for coronary artery disease of 1.07 for each micromol/L increase in homocysteine level. Hyperhomocysteinemia (values above 14 micromol/L) constituted an independent risk factor for coronary artery disease, with a risk ratio of 2.03. There was a progression of homocysteine levels between the young old and the oldest old only among the case group elderly. There was no difference among the control group elderly. There were no significant differences in vitamin levels. The rise in homocysteine levels from the young old to the oldest old may be considered not a normal pattern, but rather a pattern associated with coronary artery disease.