Management of Senile Arteriosclerosis

Lifestyle Modifications

The American Heart Association recommends tobacco cessation as the most effective lifestyle change for reducing mortality in elderly patients with arteriosclerosis, regardless of age 1
Regular exercise, including aerobic, strength, balance, and flexibility training, provides significant benefits for elderly patients with arteriosclerosis by improving functional capacity by 10-60% and decreasing myocardial work by 10-25% 2
Weight reduction and dietary modifications following the DASH diet are particularly effective in older adults, with greater blood pressure reductions than seen in younger individuals 3
Sodium restriction produces larger declines in blood pressure in older adults compared to younger individuals and should be emphasized 3

Blood pressure goals should be individualized based on age, with a target of <140 mmHg systolic for patients <79 years and 140-145 mmHg systolic for those >80 years, as recommended by the American College of Cardiology 3
Avoid excessive lowering of diastolic BP below 70-75 mmHg in older patients with coronary heart disease to prevent reduced coronary blood flow, according to the American Heart Association 3
The American College of Cardiology recommends starting antihypertensive medications at the lowest doses with gradual titration due to age-related changes in drug metabolism 5
Five major classes of antihypertensives have demonstrated efficacy in reducing cardiovascular events in older adults, including diuretics, β-blockers, ACE inhibitors, ARBs, and calcium channel blockers 6
Approximately two-thirds of elderly hypertensive patients will require two or more drugs to achieve target blood pressure, as stated by the American Heart Association 5

Statin therapy provides significant benefits in older patients with established arteriosclerosis, with relative risk reductions similar to younger patients but greater absolute risk reductions due to higher baseline risk, according to the American College of Cardiology 3
Multiple clinical trials have demonstrated that statins reduce coronary heart disease events by 24-45% and all-cause mortality by 17-33% in elderly patients, as reported by the American Heart Association 2

For elderly patients with diabetes and arteriosclerosis, less intensive glycemic targets (HbA1c 7-7.9%) are recommended, with even higher targets for frail patients or those at high risk of hypoglycemia, as suggested by the American Diabetes Association 7
Metformin is the preferred first-line therapy for diabetes in elderly patients due to its low risk of hypoglycemia, according to the American Diabetes Association 7
When insulin is required, ultra-long-acting basal and very short-acting prandial insulins are strongly preferred over intermediate-acting formulations, as recommended by the American Diabetes Association 7

Benefits of aggressive risk factor management progressively diminish in patients who are frail or have other health liabilities, such as severe dementia or life-threatening disease, according to the American Geriatrics Society 2

Regular monitoring for orthostatic hypotension is essential, especially when initiating or increasing doses of antihypertensive medications, as recommended by the American College of Cardiology 4
Assess for depression and mood instability, which are common in elderly patients with chronic disease and require appropriate therapy, according to the American Psychiatric Association 2