Our recommendations for cardiovascular disease prevention in older adults, considering frailty
| Blood pressure | For frail and not-frail patients without limited life expectancy, a goal blood pressure of < 140/90 mm Hg is reasonable with careful attention to risks, including orthostasis, falls, and polypharmacy Treatment may need to be tailored to standing blood pressure |
| Lipids | For patients over age 75 without cardiovascular disease or frailty and with a life expectancy of at least 2 years, consider a statin for primary prevention, starting at a low dose |
| Diabetes | Aim for the lowest hemoglobin A1c that does not cause hypoglycemia; relax hemoglobin A1c goals with increasing frailty Use hypoglycemic agents with caution |
| Aspirin | For patients over age 75 without frailty or cardiovascular disease and no major bleeding risk, but at high risk, consider low-dose aspirin for primary prevention of nonfatal myocardial infarction Carefully consider bleeding risk to ensure that benefit outweighs risk |
| Exercise and weight | For all older adults, and particularly those with frailty, prescribe: Balance training, such as tai chi, to decrease the risk of falls Stretching at least twice a week Moderate-intensity aerobics such as walking or swimming for 150 minutes per week Resistance training at least twice a week for 20-minute intervals General encouragement of daily activity |
| Smoking cessation | Smoking cessation remains beneficial at all ages and stages of life All counseling interventions and nicotine replacement are effective |
| Nutrition | A balanced diet, rich in whole grains, fruits, vegetables, nuts, fish, and lean meats is beneficial at all ages and stages of life |
| Unique challenges | Inappropriate polypharmacy and complexity of medication regimens increases risk of drug events and falls Multimorbidity requires the balance of multiple medical conditions to create a comprehensive plan Explore goals of care and advance directives in creating a patient-centered prevention plan; engage in shared decision-making |