How to better manage cardiovascular risk factors in the elderly ?[1]
Press release from the French Academy of Medicine
February 26, 2025
Cardiovascular diseases are the leading causes of morbidity and mortality in subjects aged 75 and over, due to age-related structural and functional alterations of heart and vessels, as well as cumulative exposure to cardiovascular risk factors (CV rf). This rapidly growing population presents significant heterogeneity in health status and functional capacities. The oldest subjects are often the most fragile as they are at highest risk of cardiovascular complications requiring both preventive and curative treatments. Furthermore, this same population is also the most vulnerable to adverse drug effects, which requires non-aggressive therapeutic strategies adapted to the individual. They may request de-prescribing, either by decreasing the doses, particularly for anti-hypertensive treatments, or by stopping some medications deemed not essential, in order to avoid the risks linked to poly-medications.
In order to avoid over-treatment of the most fragile, or under-treatment of the most robust, the French Academy of Medicine considers it necessary to develop personalized, coordinated and holistic management of CV rf in patients aged 75 and over, according to their level of frailty and functional status, and not only to their chronological age (1).
To this end, it recommends:
– Systematic screening for frailty and functional capacities in the elderly, in order to optimize objectives and therapeutic choices with regard to CV rf. This screening should be carried out by all specially trained healthcare professionals, thanks to the help of rapid scales validated and easy to master;
– Integration of de-prescribing as a therapeutic tool. This approach needs to be taught more during medical studies, and requires coordination between the attending physician, pivotal in the management of all treatments, and organ specialists;
– The use of home aids, to improve adherence to treatment and reduce medication errors (use of a pill dispenser and supervision, if necessary, by a nurse), and of connected objects;
– Improving care for residents in dependent elderly people facilities (EHPAD), by proposing the intervention of external mobile teams, deployed by healthcare professional territorial communities, to monitor regularly patients at high cardiovascular risk (on-site visits, data extraction from computerized medical records, teleconsultation);
– Promoting the inclusion of very elderly and fragile patients in clinical trials, thanks to implementation of concrete measures intended for researchers and drug manufacturers.
The effectiveness of all these proposals implementation will have to be evaluated before generalization at national level.
References
– French Academy of Medicine, Report on the management of cardiovascular risk factors in people aged 75 and over (A. Benetos and B. Bauduceau, on behalf of a working group), January 28, 2025
PRESS CONTACT: Virginie Gustin +33 (0)6 62 52 43 42 virginie.gustin@academie-medecine.fr
NATIONAL ACADEMY OF MEDICINE, 16 rue Bonaparte – 75272 Paris Cedex 06 Website: www.academie-medecine.fr / Twitter: @Acadmed
[1] 1 Press release from the Academy’s Rapid Communication Platform.
