TIME has come to have a closer look at the management of cardiovascular disease in the elderly

Individuals older than 75 years represent the fastestgrowing population segment in the western world. Coronary artery disease is the leading cause of morbidity and mortality in men as well as women in this age group. Contrary to younger individuals, rates of coronary artery disease continue to increase in the elderly and more than one third of health-care expenditures are spent on them. Therefore, the evaluation of optimal management strategies in elderly patients with symptomatic CAD is important not only for the individual, but also for society in view of health care cost. Randomized studies comparing coronary artery bypass grafting (CABG) or percutaneous coronary interventions with medical therapy in patients with chronic coronary artery disease have shown that revascularization provides symptom relief and improves survival in certain high risk subsets. Most of these were mortality trials, average age of participating patients was around 65 years and inclusion was based on ‘suitable’ coronary anatomy. In general, elderly patients are severely under-represented in randomized trials evaluating different treatment modalities for coronary artery disease. The same holds true for heart failure, another important cardiovascular problem in advanced age. As compared to their younger counterparts, important differences have to be taken into consideration in elderly patients with coronary artery disease: symptom presentation may be different, complex coronary vessel pathology, comorbid conditions and psychosocial disorders are more prevalent, tolerance to drugs is variable, side effects are more frequent and more severe, and the risk of invasive procedures is generally increased. Therefore, safety and efficacy of cardiovascular therapies may differ between elderly and younger patients and therapeutic goals may not be the same. In contrast to younger patients, the primary goal of treatment in elderly patients may no longer be prolongation of life but rather improvement in quality of life (QOL). To provide evidence-based treatment for coronary artery disease in the elderly, clinical trials designed specifically for this age group are urgently needed.