Implications of age in coronary artery disease progression. A serial, volumetric, intravascular ultrasound study

Background: The implications of age on clinical and angiographic manifestations of coronary artery disease are well established. Elderly Patients (P) are classically under-represented in clinical trials and are less likely to be fully investigated and to receive well established therapies. However, the potential influence of age on atherosclerosis progression remains poorly defined. Objective: The purpose of this study was to determine the relationship between age and the extent of coronary atherosclerosis and its progression rate. Methods: 200 consecutive P (mean age 65±10 years, 45 [22%] female) undergoing Serial Intravascular Ultrasound (IVUS) studies (median time interval 366 days) were analyzed. Of these, 39 P (19,5%) were ≥ 75 years of age (elderly). A validated system for volumetric IVUS analysis (EchoScan, TOMTEC) was used for off-line three-dimensional reconstruction and volumetric analysis. Both age groups were compared with regard to baseline characteristics, coronary atheroma burden, and disease progression at follow-up. Study end-points were absolute and percent change (delta) in plaque volume as detected by IVUS. Results: Elderly P had a more adverse cardiovascular risk profile, including diabetes and hypertension. Despite this adverse clinical profile, medical therapy was similar in both groups. However, baseline Total Atheroma Volume (TAV) and Percent AtheromaVolume (PAV) were similar in both groups. Furthermore, at late follow-up, changes in TAV and PAV were also similar in both groups. View this table: Table 1. Clinical characteristics and changes in atheroma burden according to age Conclusions: Despite an adverse clinical profile elderly P with established coronary artery disease have a similar extent of coronary atheroma burden than younger P. Coronary atheroma progression is also similar in both age groups, emphasizing the need for implementing of aggressive preventive therapeutic strategies irrespective of P age.