Cardiovascular disease in the elderly.

Cardiovascular disease is the major cause of death and disability in the elderly. Atherosclerotic coronary heart disease is the most prevalent problem, followed by hypertensive cardiovascular disease. Calcific aortic stenosis is the most common haemodynamically important valvular lesion; surgical correction significantly improves the prognosis. Pulmonary embolism occurs frequently, related to immobilization and co-morbidity. Congestive heart failure is both under-diagnosed and over-diagnosed. Complete heart block and sick sinus syndrome increase with age; appropriate pacemaker therapy can improve the length and quality of life. Clinical evaluation of elderly patients is often hampered by multiple co-existing disease involving other organ systems, problems in reporting symptoms, and associated functional and structural changes of ageing that may mimic or mask cardiovascular disease. Presentations of cardiac illness often differ from those in a younger population. Most of the available data on therapy and prognosis do not apply to contemporary practice, so that clinical decisions are often extrapolated from information acquired in younger patients. Elderly patients are at high risk of complications of most diagnostic and therapeutic procedures, more related to co-morbidity than to age; they have more frequent and serious adverse drug reactions, due both to co-morbidity and to multiple medications. Age as such should not constitute a barrier to cardiac care; in the USA at least one-third of all cardiovascular procedures are performed in elderly patients. The goals of therapy are improvement in function and postponement of debilitating illness, enabling an extended active independent lifestyle.