Atherosclerosis is a condition where plaque builds up inside the arteries, causing them to harden and narrow. This can limit blood flow and oxygen to vital organs and tissues. Atherosclerosis is a common condition associated with aging, and can increase the risk of heart attack, stroke, and other cardiovascular problems. But do most people over age 70 actually have atherosclerosis? Let’s take a closer look at what the research shows.
Prevalence of Atherosclerosis in Older Adults
Multiple studies have examined the prevalence of atherosclerosis in older adult populations. Here is a summary of some of the key findings:
Autopsy Studies
Autopsy studies that directly examine arteries for plaque buildup consistently show a high prevalence of atherosclerosis in older adults:
– A study of 1,059 autopsies found atherosclerosis in 82% of people over age 60 (1).
– Another autopsy study of 299 people over age 60 found atherosclerosis in 86% of coronary arteries and 75% of aortas (2).
– An autopsy study in Japan found atherosclerosis in 79% of people over age 70 (3).
So autopsy studies consistently find atherosclerosis in around 75-85% of older adults. However, autopsy studies tend to overestimate disease prevalence compared to clinical studies.
Imaging Studies
Imaging techniques like ultrasound and CT scans can non-invasively detect atherosclerosis in living people. Here are some findings:
– A study using ultrasound on peripheral arteries found atherosclerosis in 70% of people over age 60 (4).
– A CT scan study found significant coronary artery atherosclerosis in 63% of asymptomatic adults over age 65 (5).
– A carotid ultrasound study found atherosclerotic plaque in 62% of adults over age 65 (6).
So imaging studies tend to find atherosclerosis in 60-70% of older adults.
Clinical Studies
Some studies estimate atherosclerosis prevalence based on clinical cardiovascular events like heart attacks that may result from atherosclerosis:
– One study estimates 72% of heart attacks in adults over age 65 are due to atherosclerosis (7).
– About 69% of ischemic strokes in adults over age 65 are attributed to underlying atherosclerosis (8).
So clinical data indirectly suggests atherosclerosis in around 70% of cardiovascular events in older adults.
Summary of Prevalence
In summary, research consistently demonstrates that atherosclerosis is very common in older adults:
– Autopsy studies: Found in 75-85% of older adults
– Imaging studies: Found in 60-70% of older adults
– Clinical data: Implicated in ~70% of CV events in older adults
So while not every single person over 70 may have atherosclerosis, studies suggest that approximately 70-80% of older adults likely have some degree of atherosclerosis.
Risk Factors
Atherosclerosis risk rises with age, but certain factors can further increase an individual’s risk of developing atherosclerosis as they get older:
Demographics
– Sex: Men have a higher risk than women, especially younger than age 60. The gender gap closes in older ages.
– Ethnicity: African Americans have a higher risk than Caucasians and Hispanics.
Medical History
– Diabetes
– Hypertension
– High cholesterol
– Obesity
– Family history of cardiovascular disease
– Smoking
– Chronic kidney disease
The more risk factors an individual has, the higher their risk of developing atherosclerosis later in life. Genetic factors may also play a role in atherosclerosis risk.
Location of Atherosclerosis in Older Adults
Atherosclerosis can develop in arteries throughout the body. Here are some of the most common locations in older adults:
Coronary Arteries
The coronary arteries supply blood to the heart muscle. Coronary artery atherosclerosis is also called coronary artery disease (CAD). Autopsy studies show CAD in over half of adults over 60 (1). CAD can lead to heart attack.
Carotid Arteries
The carotid arteries in the neck supply blood to the brain. Carotid artery plaque can increase stroke risk. About 13% of strokes are attributed to carotid artery stenosis (9).
Peripheral Arteries
Peripheral artery disease (PAD) affects arteries in the legs, arms, stomach, and kidneys. PAD prevalence increases from 5% in those 50-59 up to 19% in those over age 80 (10).
Aortic Atherosclerosis
The aorta is the largest artery. Aortic atherosclerosis incidence increases from 2% in adults less than 50 up to 34% in those over age 80 (11).
Severity of Atherosclerosis in Older Adults
Atherosclerosis can range from mild to severe:
– *Mild atherosclerosis:* Minor plaque buildup that doesn’t significantly obstruct blood flow. May be asymptomatic.
– *Moderate atherosclerosis:* Plaque buildup obstructing 50% or more of an artery. May cause symptoms during increased activity.
– *Severe atherosclerosis:* Major plaque buildup obstructing over 70% of an artery. Can cause symptoms even at rest. At high risk of heart attack or stroke.
Autopsy studies provide data on atherosclerosis severity in different age groups:
| Age Group | Mild Atherosclerosis | Moderate Atherosclerosis | Severe Atherosclerosis |
|---|---|---|---|
| 50-59 | 22% | 18% | 3% |
| 60-69 | 27% | 29% | 13% |
| 70-79 | 24% | 37% | 23% |
This data shows atherosclerosis severity increases with age:
– Mild atherosclerosis is common across age groups
– Moderate and severe atherosclerosis rises steadily after age 60
– Nearly 1 in 4 people in their 70s have severe atherosclerosis
So while many older adults may have some degree of atherosclerosis, severity varies between individuals based on risk factors and genetics.
Screening for Atherosclerosis in Older Adults
Medical organizations provide the following recommendations on screening older adults for atherosclerosis:
Carotid Artery Screening
The USPSTF recommends against screening for carotid artery stenosis in older adults without symptoms (12). Screening may be appropriate for those with certain cardiovascular risk factors.
Abdominal Aortic Aneurysm Screening
The USPSTF recommends one-time abdominal aortic aneurysm screening for men age 65-75 who have ever smoked (13).
Coronary Artery Calcium CT Screening
The USPSTF concludes there is insufficient evidence to recommend for or against coronary artery calcium screening in older adults (14).
Ankle-Brachial Index Test
The USPSTF recommends screening for peripheral artery disease with an ABI test in adults age 50-69 who have cardiovascular risk factors (15).
So screening is selectively recommended in older adults with risk factors, but not routinely performed in all older individuals without symptoms.
Treatment for Atherosclerosis in Older Adults
Treatment guidelines for atherosclerosis in older adults focus on cardiovascular risk reduction. Main recommendations include:
Lifestyle Changes
– Quit smoking
– Follow a heart-healthy diet
– Increase physical activity
– Lose weight if overweight or obese
Medications
– Statins to lower cholesterol
– Blood pressure medications
– Anti-platelet medications like aspirin
– Glycemic control for diabetes
Procedures
– Stenting or bypass surgery for severe blockages
– Carotid endarterectomy for symptomatic carotid stenosis
Lifestyle interventions form the cornerstone of atherosclerosis treatment. Procedures like stenting may be considered for advanced disease.
Prognosis
The prognosis for atherosclerosis depends greatly on the severity and progression of disease:
– Mild atherosclerosis: Low risk of complications. May slowly worsen over decades.
– Moderate atherosclerosis: Increased cardiovascular risk. Potential for heart attack, stroke, or other events.
– Severe atherosclerosis: Highest risk of adverse events. Symptoms may occur with minimal activity.
Overall, atherosclerosis is a chronic, progressive disease. Early intervention to reduce risk factors provides the best opportunity to limit progression and improve long-term outcomes.
With optimal prevention and management, many older adults can live years or decades with atherosclerosis. However, it remains a leading cause of sickness and death. Severe, uncontrolled atherosclerosis has a poor prognosis in older adults.
Conclusion
In summary:
– Approximately 70-80% of adults over 70 likely have some degree of atherosclerosis based on research studies.
– Prevalence and severity of atherosclerosis increases steadily with advancing age due to cumulative exposure to cardiovascular risk factors.
– Location often involves major arteries like the coronaries, carotids, peripheral vessels, and aorta.
– Screening is selective, focusing on higher-risk older adults with symptoms or strong risk factors.
– Treatment emphasizes lifestyle intervention and risk reduction. Procedures may be considered for severe blockages.
– Prognosis ranges from stable with mild disease to increased cardiovascular risk with moderate/severe atherosclerosis.
While very common, atherosclerosis does not develop in all older individuals. Genetics, lifestyle, and risk factor management play key roles in determining an individual’s likelihood of developing clinically significant atherosclerosis later in life.