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Cardiovascular Disease in the Elderly: Prevention and Diagnosis
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Cardiovascular Disease in the Elderly: Prevention and Diagnosis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 20 November 2025 | Viewed by 3465

Special Issue Editors

Prof. Dr. Ioana Dana Alexa

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Guest Editor
Department of Medical Specialties II, Universitatea de Medicina si Farmacie Grigore T. Popa din Iasi, Iasi, Romania
Interests: palliative care; iatrogeny; cardiology; communication in geriatrics
Prof. Dr. Gabriel Ioan Prada

E-Mail Website
Guest Editor
National Institute of Gerontology and Geriatrics, Bucharest, Romania
Interests: older adults quality of life; elderly patients; geriatrics
Prof. Dr. Ciprian Rezus

E-Mail Website
Guest Editor
Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
Interests: cardiology; internal medicine; heart failure; atherosclerosis; arterial hypertension
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiovascular diseases remain the most important cause of death in the elderly population. There is an increased prevalence of cardiovascular diseases in older people due to the addition of new risk factors, such as physiological changes in the cardiovascular system with aging, frailty and sarcopenic obesity; the impact of the unfavorable evolution of the concomitant chronic diseases; polypharmacy; and iatrogeny.

The elimination of cardiovascular risk factors has greater effects in the elderly than in other age groups.

The symptoms and clinical examination could be atypical compared to the classic ones, or they could be replaced by symptoms borrowed from other concomitant diseases (ulcer, pancreatitis, pleuritis, equivalents of dyspnea) or even be absent. This is why the diagnosis of the main cardiovascular problems in the elderly can easily be overlooked or overused.

Investigations that would provide a good starting point in the diagnosis of these conditions are ECG and Holter ECG monitoring, which allow us to record potential episodes of silent ischemia, as well as heart rate variability and echocardiography.

This Special Issue will provide new information on the prevention and diagnosis of cardiovascular diseases in old people based on a combination of original research and review papers.

Topics of interest include the following:

  • New cardiovascular risk factors in elderly patients, such as frailty, the risk of falling, sarcopenic obesity, heart rate variability, and insulin resistance;
  • Diagnostic approaches in elderly patients with heart failure and type 2 diabetes;
  • Cardiovascular pathology and concomitant diseases in elderly patients and the importance of preserving good resilience and intrinsic capacity.

The complex management of elderly patients with cardiovascular diseases and multiple concomitant problems, as well as the importance of medication reconciliation.

Prof. Dr. Ioana Dana Alexa
Prof. Dr. Gabriel Ioan Prada
Prof. Dr. Ciprian Rezus
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiovascular risk factors
  • elderly patients
  • frailty, sarcopenia
  • heart rate variability
  • insulin resistance
  • physical resilience
  • intrinsic capacity
  • diastolic dysfunction

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Published Papers (6 papers)

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Research

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13 pages, 525 KiB  
Article
Cardiovascular Pharmacotherapy and Falls in Old People: Risks and Prevention—An Observational Case–Control Study
by Sorina Maria Aurelian, Anca Iuliana Pîslaru, Sabinne-Marie Albișteanu, Sonia Dragoescu, Sandra Monica Gîdei, Adina Carmen Ilie, Ramona Ștefăniu, Corina Oancea, Ana-Gabriela Prada and Ioana Dana Alexa
J. Clin. Med. 2025, 14(13), 4570; https://doi.org/10.3390/jcm14134570 - 27 Jun 2025
Viewed by 172
Abstract
Background: Falls are a major cause of morbidity and mortality among older adults and are influenced by comorbidities and polypharmacy. Cardiovascular diseases (CVDs) and their associated treatments are particularly prevalent in this population and may contribute to fall risk. Objectives: The objectives of [...] Read more.
Background: Falls are a major cause of morbidity and mortality among older adults and are influenced by comorbidities and polypharmacy. Cardiovascular diseases (CVDs) and their associated treatments are particularly prevalent in this population and may contribute to fall risk. Objectives: The objectives of this study were to examine the association between cardiovascular pharmacotherapy and fall risk in older adults and to identify potential preventive strategies. Methods: This observational case–control study was conducted between June and December 2024 and included 200 participants aged over 55 years who provided informed consent. Participants were assessed using the Downton Fall Risk Index and divided into two equal groups, with those at high risk of falling and controls. All participants underwent a comprehensive geriatric assessment, including anamnesis, clinical evaluation, and laboratory testing focused on cardiovascular risk factors. The prevalence of CVD and the use of specific cardiovascular medications were analyzed. Results: Patients at high risk of falling showed significant differences compared to the control group in several parameters, including systolic blood pressure (SBP: 140.41 mmHg vs. 151.28 mmHg, p = 0.001), ankle brachial index (left ABI: 1.09 vs. 1.15., p = 0.033), and presence of cardiovascular diseases (p = 0.001), as well as total cholesterol (p = 0.005) and triglyceride levels (p = 0.047). Certain cardiovascular medications were significantly associated with increased fall risk, including spironolactone (OR = 4.10, p = 0.001), beta-blockers (OR = 1.88, p = 0.031), and calcium channel blockers (OR = 2.05, p = 0.014), especially in combination with one another. Additional risk factors included frailty, cognitive impairment, diabetes, and neurological or osteoarticular conditions. Interventions such as medication review, deprescribing, and dosage adjustments may help reduce fall risk without compromising cardiovascular disease management. Conclusions: Cardiovascular diseases and related pharmacotherapy are significantly associated with an increased risk of falls in older adults. Regular medication reviews, deprescribing where appropriate, and individualized treatment plans may help minimize fall risk while maintaining the effective cardiovascular care of this vulnerable population. Full article
(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Prevention and Diagnosis)
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16 pages, 283 KiB  
Article
Muscle or Heart? Functional Impact of Sarcopenia and Heart Failure in Geriatric Inpatients
by Valer Donca, Dana Crişan, Camelia Alexandra Coada, Laurenţiu Stoicescu, Elena Buzdugan, Alin Grosu, Mihai Lupu and Lucreţia Avram
J. Clin. Med. 2025, 14(12), 4288; https://doi.org/10.3390/jcm14124288 - 16 Jun 2025
Viewed by 358
Abstract
Objectives: To evaluate the individual and combined impact of sarcopenia (SARC) and heart failure (HF) on functional performance, systemic biomarkers, and structural cardiac changes in hospitalized older adults. A total of 598 patients aged ≥65 years admitted to a geriatric unit between January [...] Read more.
Objectives: To evaluate the individual and combined impact of sarcopenia (SARC) and heart failure (HF) on functional performance, systemic biomarkers, and structural cardiac changes in hospitalized older adults. A total of 598 patients aged ≥65 years admitted to a geriatric unit between January 2023 and December 2024, stratified into four groups based on the presence or absence of sarcopenia and HF. Methods: Muscle strength (handgrip), gait speed, SPPB score, and calf circumference were assessed, along with inflammatory/nutritional markers and echocardiographic parameters. Sarcopenia was diagnosed according to EWGSOP2 criteria and HF was diagnosed according to ESC 2021 guidelines. Results: Functional impairment was the most severe in the SARC+/HF+ group, with significantly lower handgrip strength, gait speed, and SPPB scores (p < 0.001). Sarcopenia alone was associated with greater functional decline than HF alone. Serum hemoglobin and albumin levels were reduced in sarcopenic groups, while NT-proBNP and cardiac remodeling indices (IVS and LVEDD) were highest in patients with both conditions. Conclusions: Sarcopenia exerts a significant impact on physical performance in older adults, surpassing that of HF in isolation. The coexistence of sarcopenia and HF amplifies vulnerability and clinical decline, supporting the need for integrated assessment and early muscle-targeted interventions in geriatric cardiology. Full article
(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Prevention and Diagnosis)
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11 pages, 501 KiB  
Article
Association of Sarcopenia and Visceral Obesity with Clinical Outcomes Among Older Adults with Cardiovascular Disease: A Retrospective Cohort Study
by Hye-Jin Yoon, Keon-Woo Park and Young-Hoon Seo
J. Clin. Med. 2025, 14(12), 4191; https://doi.org/10.3390/jcm14124191 - 12 Jun 2025
Viewed by 480
Abstract
Background/Objectives: The clinical implications of sarcopenia and visceral obesity in patients with cardiovascular disease (CVD) are poorly understood. We evaluated the impact of sarcopenia and visceral obesity on clinical outcomes among older adults with CVD. Methods: This retrospective cohort study included patients aged [...] Read more.
Background/Objectives: The clinical implications of sarcopenia and visceral obesity in patients with cardiovascular disease (CVD) are poorly understood. We evaluated the impact of sarcopenia and visceral obesity on clinical outcomes among older adults with CVD. Methods: This retrospective cohort study included patients aged 65 years and older who had cardiovascular disease and had undergone body composition analysis using dual-energy X-ray absorptiometry (DXA) between November 2021 and October 2022 and been followed through February 2024. Sarcopenia was defined using the 2019 Asian Working Group for Sarcopenia criteria, and visceral obesity was defined using Korean sex-specific visceral adipose tissue area. The primary outcome was a composite of all-cause mortality and major cardiovascular events, including myocardial infarction, stroke, hospitalization for heart failure, and coronary revascularization. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. Results: A total of 317 patients were included, of whom 118 patients (37.2%) had sarcopenia, 184 (58.0%) had visceral obesity, and 55 (17.4%) had sarcopenic obesity. The prevalence of sarcopenia or visceral obesity was 93.8% in patients with obesity and 69.3% in those without obesity. Sarcopenic obesity showed a mixture of characteristics of two metabolic conditions in terms of demographics and body mass index. Sarcopenia was associated with an increased risk of primary outcomes (hazard ratio [HR], 1.93; 95% CI, 1.02–3.66), with the highest risk observed in patients with sarcopenic obesity (HR, 6.74; 95% CI, 1.81–25.16). Conclusions: Sarcopenia was associated with 1.9-fold increased risk of cardiovascular events among older adults with CVD, with a greater than 6-fold increased risk when combined with visceral obesity. Full article
(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Prevention and Diagnosis)
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15 pages, 301 KiB  
Article
Heart Rate Variability: Marker of the Impact of Cardiovascular Disease on Intrinsic Capacity in Older Adults
by Ana-Maria Turcu, Adina Carmen Ilie, Sabinne-Marie Albișteanu, Gabriela Grigoraș, Iulia-Daniela Lungu, Ramona Ștefăniu, Anca Iuliana Pîslaru and Ioana Dana Alexa
J. Clin. Med. 2025, 14(9), 2981; https://doi.org/10.3390/jcm14092981 - 25 Apr 2025
Viewed by 723
Abstract
Objective: This study investigates the association between heart rate variability parameters—particularly SDNN or SDANN—and components of intrinsic capacity in older adults, including functional, nutritional, cognitive, psycho-emotional domains, and frailty. Primary outcomes assess the relationship between SDNN and SDANN and frailty status and functional [...] Read more.
Objective: This study investigates the association between heart rate variability parameters—particularly SDNN or SDANN—and components of intrinsic capacity in older adults, including functional, nutritional, cognitive, psycho-emotional domains, and frailty. Primary outcomes assess the relationship between SDNN and SDANN and frailty status and functional performance (ADL/IADL scores, handgrip strength). Secondary outcomes assess the relationship between SDNN and SDANN and cognitive status (MMSE), nutritional status (MNA, BMI, total protein, hemoglobin, visceral fat), emotional well-being (GDS), and urinary incontinence. Methods: This prospective exploratory study included 83 patients over the age of 65, hospitalized between January and October 2024. All participants underwent cardiovascular evaluation and evaluation of intrinsic capacity (frailty status, ADL/IADL, handgrip strength, MMSE, MNA, GDS, urinary incontinence). Results: Patients were grouped by SDNN values (<128 ms vs. ≥128 ms). Those with lower SDNN had significantly lower MNA scores (p = 0.047), lower hemoglobin (ρ = 0.220, p = 0.046), and higher GDS scores (ρ = −0.219, p = 0.047), indicating poorer nutritional and emotional status. SDANN was negatively correlated with frailty scores (ρ = −0.269, p = 0.014) and positively correlated with ADL scores (ρ = 0.247, p = 0.024), suggesting better functional independence. Handgrip strength was significantly predicted by both SDNN (p = 0.002) and SDANN (p = 0.002) in univariable linear regression. Visceral fat levels were positively correlated with SDNN (ρ = 0.292, p = 0.007), though BMI was not. No significant associations were found between HRV parameters and MMSE scores or urinary incontinence. Conclusions: HRV parameters, particularly SDNN and SDANN, show modest but significant associations with intrinsic capacity components such as frailty, functional performance, nutritional status, and emotional well-being in older adults. These findings suggest that SDNN and SDANN may serve as non-invasive markers for the early identification of declines in intrinsic capacity. Larger longitudinal studies are needed to validate these preliminary results. Full article
(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Prevention and Diagnosis)
14 pages, 9828 KiB  
Article
Cardiotoxicity Associated with Venlafaxine—Defining Features in a Series of Five Cases and a Call for Proactive Monitoring
by Bujana Batusha Sopi, Keiko Yonekawa, Stefan Russmann, Jasminka Bernheim, Stefano Caselli, Christian Schmied, Helene Hammer, Anna Lam and Christine Attenhofer Jost
J. Clin. Med. 2025, 14(8), 2792; https://doi.org/10.3390/jcm14082792 - 18 Apr 2025
Cited by 1 | Viewed by 989
Abstract
Background/Objectives: Venlafaxine (VEN) is a serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant. Arterial hypertension (HTN), heart failure (HF), and arrhythmias are side effects of VEN. Cardiotoxicity (CTOX) as a feature of VEN-associated side-effects has only rarely been described. Methods: We conducted a search [...] Read more.
Background/Objectives: Venlafaxine (VEN) is a serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant. Arterial hypertension (HTN), heart failure (HF), and arrhythmias are side effects of VEN. Cardiotoxicity (CTOX) as a feature of VEN-associated side-effects has only rarely been described. Methods: We conducted a search of our database for cases of VEN-associated CTOX, analyzing symptoms, echocardiographic findings, and laboratory results. Results: We identified five patients (three females, two males) with VEN-associated CTOX, aged 51 to 87 years at presentation. VEN dose was 150 and 375 mg daily and treatment duration was 1.5 to 15 years. Presenting features were HTN in three, “hypertrophic cardiomyopathy” in two, heart failure in three, and atrial fibrillation in three patients. Symptoms and signs of CTOX were reversible in all patients after discontinuation or dose reduction of VEN, suggesting a causal relationship between VEN and CTOX. Conclusions: VEN-associated CTOX can occur and progress to severe cardiomyopathy or heart failure. Potential risk factors include cardiac sympathetic stimulation, high VEN dosage, and prolonged treatment duration; however, CTOX may also occur at standard doses. Therefore, patients taking VEN should be routinely monitored for signs of cardiotoxicity, including monitoring of serum concentrations of VEN. Full article
(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Prevention and Diagnosis)
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Review

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22 pages, 755 KiB  
Review
The Use of Direct Oral Anticoagulants (DOACs) in the Geriatric Population—How to Overcome the Challenges of Geriatric Syndromes
by Minerva Codruta Badescu, Diana Popescu, Evelina Maria Gosav, Alexandru Dan Costache, Diana Elena Cosău, Adriana Chetran, Ștefania-Teodora Duca, Sandu Cucută, Ionela Lăcrămioara Șerban, Irina Iuliana Costache Enache and Ciprian Rezus
J. Clin. Med. 2025, 14(13), 4396; https://doi.org/10.3390/jcm14134396 - 20 Jun 2025
Viewed by 258
Abstract
Because the number of elderly people is increasing worldwide, and the prevalence of cardiovascular risk factors and cardiovascular diseases increase with age, in current clinical practice we are faced with a large number of geriatric patients requiring oral anticoagulant treatment. Our review highlights [...] Read more.
Because the number of elderly people is increasing worldwide, and the prevalence of cardiovascular risk factors and cardiovascular diseases increase with age, in current clinical practice we are faced with a large number of geriatric patients requiring oral anticoagulant treatment. Our review highlights some of the particularities of using direct oral anticoagulants (DOACs) in the geriatric population. We focused on the difficulties of managing DOAC treatment in the presence of geriatric syndromes. We highlighted the practical steps needed to overcome the challenges related to the risk of falling, cognitive impairment, swallowing disorders, and polypragmasy to improve patient care. We provided data to help guide the choice of anticoagulant and dose. Full article
(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Prevention and Diagnosis)
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