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Many of the normal cardiovascular concerns of aging are complicated for adult survivors of congenital heart disease, which the American Heart Association delved into with a new .

The statement, appearing online in Circulation, addressed "older adults" -- defined as those 40 and older.

While 40 might be considered young for most cardiology practices, only now are many congenital heart disease patients surviving to reach middle age and some into the geriatric age range, , co-director of the adult congenital heart disease program at Massachusetts General Hospital in Boston, and colleagues noted in the document.

"It is encouraging for the field of adult congenital heart disease that the treatment of the older adult is an issue that is now upon us, and it is an exciting time as our management strategies must now evolve along with this population of patients," they wrote.

Fifty years ago, only about 15% of complex congenital patients were expected to survive into adulthood, commented , director of adult congenital heart services at the Cleveland Clinic.

Among the issues of middle and older age addressed by the statement were acquired heart disease, which it noted can be tricky to separate from the effects of the original condition and surgeries, and the need for a team approach with congenital heart disease experts in its diagnosis and treatment.

Even life changes like menopause are influenced by these patients' cardiac history, according to Bhatt's group.

Menopausal hormone therapy (HRT) decisions have to take into account the elevated venous thromboembolic disease risk that persists after certain types of congenital heart disease treatment, they noted.

"For example, women with Fontan surgery have a high risk of venous thromboembolism and should avoid HRT, whereas women with tetralogy of Fallot repair and good right ventricular function have a low risk and could probably receive HRT for symptoms," they wrote.

Transdermal estrogen might be considered, given its lower clotting risk, the statement suggested. Also, vaginal estrogen can be useful for symptomatic vaginal dryness, the statement added.

For men, erectile dysfunction drugs "are safe for most patients in whom sexual activity is reasonable, as long as they are not taking nitrate therapy," although their effectiveness isn't clear for those with severe ventricular outflow tract obstruction.

While surveys indicate many adult congenital heart disease patients worry about sex, it should be reasonable for those without decompensated or advanced heart failure, severe or significantly symptomatic valvular disease, or uncontrolled arrhythmias, Bhatt's group wrote.

The statement also addressed risk factor control -- of heightened importance given the elevated risk of heart failure, valve dysfunction, pulmonary hypertension, and arrhythmias in this population -- and practical issues like keeping records of childhood diagnoses and corrective surgeries to provide to their physicians.

While the scientific statement noted that there's little randomized controlled trial evidence for treatment of these patients, Krasuski called this statement notable for citing recent literature whereas prior guidelines have largely cited decades-old data.

"For many years this was the field of cowboys," he told MedPage Today. "It was more just experience driven. Now it has become a field that has an evidence base and an evidence base that is growing every day."

From the American Heart Association:

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