Subclinical cardiovascular disease linked to a higher risk of falling in the elderly

Every year, one in three American adults over the age of 65 falls – and the number of deaths from falls is increasing. Falls cost the US health care system more than $ 23 billion in emergency room visits each year. Worse still, they often contribute to serious injuries in the elderly, often resulting in persistent disability and premature death.

A study published today in the Journal of the American Geriatrics Society identifies new factors that contribute to falls, indicating interventions that can help prevent them. Researchers led by Stephen Juraschek, MD, Ph.D., primary care physician at Beth Israel Deaconess Medical Center (BIDMC), found that subclinical myocardial damage and heart tension were badociated with a higher risk of falling elderly without known cardiovascular disease. These results suggest that optimizing cardiovascular health even in the elderly without a diagnosis of CVD could represent a fall prevention strategy for older adults.

Since falls can often be fatal for older adults, greater awareness of the factors that contribute to falls is an important public health priority. For the first time, our study shows that subclinical CVD is in itself a risk factor for falls. This raises the important question of whether the treatment of subclinical cardiovascular disease could help prevent falls in the elderly. "

Stephen Juraschek, MD, Ph.D., Primary Care Physician, Beth Israel Deaconess Medical Center

Juraschek and his colleagues followed nearly 4,000 older adults (average age 75) for four and a half years. During this time, participants were asked to report any hospitalization; and their medical records and claims data from Medicare Centers and Medicaid Services (CMS) were linked to the information in their study. The falls were identified from ICD-9 hospital discharge codes or CMS claims.

In this elderly population living in the community with no known CVD, stroke or heart failure, the researchers found that markers of subclinical myocardial injury and cardiac wall stress were strongly and independently badociated with further falls. These results suggest that biomarkers of heart damage and wall fatigue could be important risk factors for falls and could inform new independent pathways linking CVD to falls in older adults with no clinical history of CVD.

"Our findings are instructive for clinical discussions on both primary prevention of CVD and fall intervention in older adults," Juraschek said. "Although the treatment of subclinical cardiovascular diseases may help prevent falls among older adults is beyond the scope of this study, but is an important topic for future research on falls prevention." Such research could inform practitioners risks and benefits of primary prevention treatments for older people at risk of falls. "