Background: Polypharmacy is commonly defined as the use of multiple or unnecessary medications. In the elderly, polypharmacy is a long-standing issue with reported rates between 30% and 70% due to multiple chronic disease diagnoses, misidentified adverse drug reactions or both. Polypharmacy is associated with increased healthcare costs, adverse drug events and interactions, medication non-adherence, decreased functional ability to perform activities of daily living, falls, malnutrition, urinary incontinence, impaired cognition and mortality. It has been reported that as many as 75% of polypharmacy-related adverse events are potentially preventable, and there is recent interest in deprescribing or reducing the number of unnecessary medications. Cardiovascular disease is the leading cause of death in the USA and globally. According to National Health and Nutrition Examination Survey data, approximately 85% of US adults over the age of 80 have cardiovascular disease. Current treatment guidelines for cardiovascular disease recommend both pharmaceutical therapy and lifestyle modifications, such as diet and physical activity. Yet commonly used medications provide low absolute risk reduction of cardiovascular events and all-cause mortality and pose significant risk of adverse events. Furthermore, most physicians feel inadequately trained to advise patients about food and eating behavior, and less than half of primary care physicians routinely discuss diet with patients diagnosed with cardiovascular disease. However, intensive lifestyle modifications, including plant-based diets, have shown high rates of adherence and acceptability in multiple patient populations.
The case reported here establishes a basis for the use of an exclusively plant, whole-food diet free of salt, oil and sugar (SOS-free) and moderate physical activity to improve cardiovascular risk biomarkers, reverse symptoms associated with atrial fibrillation and ischaemic cardiomyopathy and reduce polypharmacy in the elderly.