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Coronary heart disease (CHD) is the most common cause of mortality and morbidity in the elderly. In western countries, it accounts for 80 – 85 percent of all cardiac deaths in older people.

When a person ages, his or her cardiovascular system will undergo some normal and expected changes. These can be age-associated changes in cardiac anatomy; age-associated changes in cardiovascular physiology; and age-associated changes in pharmacokinetics and pharmacodynamics.

The presentation of CHD may be altered by these changes together with other age-related changes in the kidneys, brain, and musculoskeletal systems. Ultimately, the diagnosis and hence the treatment of heart disease in elderly may become more complicated.

Various conventional risk factors for CHD among younger people such as smoking, hypertension, hyperlipidemia and diabetes mellitus remain important factors for elderly. Furthermore, age is a powerful and independent risk factor for CHD. The risk increases when men reach 55 years old and above and women reach 65 years old and above.

Females have a much lower risk of CHD compared to males, but this gender differential diminishes as age advances. For example, the event rate is 1:5 in favor of females at the age of 35, but by the age of 70, the ratio is almost 1:1.

Symptoms such as breathlessness, giddiness or palpitation are quite common for the CHD in the elderly. Sometimes, musculoskeletal problem in the elderly may prevent the patient from complaining of exercise related angina. Instead of complaining of chest pain during a heart attack, an elderly patient may develop difficulty in breathing or symptom of stroke. Silent heart attack is also common. As reported in the Cardiovascular Health Study and the Framingham Heart Study, some 40 percent of unrecognized heart attack was found in those aged between 75 and 84 years.

In the management of heart disease, some diagnostic procedures such as treadmill exercise may not be suitable because of the associated joint problems in the elderly. It is also more risky to perform coronary angiography and coronary angioplasty procedures for the elderly patients with the presence of diminished kidney function. Following a heart attack, the in-hospital mortality and risk of subsequent reinfarction or its complications are all increased in the elderly patients. The use of clot busting medication (thrombolytics) has an increased risk of cerebral hemorrhage in the very elderly. Some age-associated changes in kidney or gastrointestinal function may require reduction in the usual drug dosages when heart medications are used in older patients.

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