Key result
Individualized CV pharmacotherapy balances event reduction against adverse effects in frail older adults.
Why the study?
The global prevalence and impact of frailty on cardiovascular outcomes are increasing, posing unique challenges for cardiovascular pharmacotherapy in older people.
Cardiovascular pharmacotherapy in frail older adults requires a personalized approach that carefully weighs the benefits of treatment against the heightened risk of adverse drug effects.
Requires frailty assessment before CV therapy in older adults; leaves open RCT validation of personalized regimens.
The prevalence of frailty and its effect on cardiovascular outcomes is increasing on a global scale. Pharmacotherapies for cardiovascular diseases in older people with frailty present unique challenges that require a comprehensive and individualized approach. In this Review, we provide a general overview of these challenges, followed by an in-depth discussion of the problems inherent in applying standard approaches to cardiovascular care in this population. Specifically, we consider blood pressure control, glucose lowering in patients with type 2 diabetes mellitus, lipid lowering, antiplatelet therapies, direct oral anticoagulants for stroke prevention in atrial fibrillation, and the treatment of heart failure. Although the reduction in cardiovascular events in older individuals with frailty is crucial, the potentially increased risk of adverse effects with the use of cardiovascular medications must be carefully considered. Treatment targets and the choice of drug for these patients should be based on their overall health status and personal goals of care.
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Nguyen et al. (2026) studied this question. Individualized cardiovascular pharmacotherapy is essential for older adults with frailty to balance reducing events with minimizing adverse effects.
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