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Cardiovascular disease (CVD) in the elderly is a problem of rapidly growing importance. The prevalence in CVD in older persons is currently about three-fold that in younger populations.1 Further, with the disproportionate growth of the elderly population worldwide, the numbers of older patients with CVD will expand considerably. Also contributing to the impact of CVD in the elderly is the sharp increase in the risk of adverse CVD outcomes that occurs with increasing age.2 Finally, the greater comorbidity associated with older age contributes to a more complex CVD patient population.3,4 This confluence of factors creates an increasingly urgent need to understand effective strategies to ameliorate the burden of CVD in older persons.Historically, however, clinical trials in CVD have focused on young populations and those without substantial comorbidity. The limited enrolment of elderly patients is likely due to several factors, such as concerns about follow-up or competing risks, both of which may threaten trials’ internal validity or power. However, the failure to include adequate numbers of older patients represents a serious threat to the external validity of trials. For example, among US Medicare beneficiaries hospitalized with heart failure, <25% of patients met the enrolment criteria for the landmark clinical trials that established the efficacy of ACE-inhibitors, beta-blockers, and aldosterone antagonists.5 Thus, in many cases, clinicians face the increasing problem of providing care for patient populations for which the evidence base is either rudimentary or non-existent.The analysis by Gianni et al .6 is an important initial step towards filling in the substantial deficiencies in the existing evidence base addressing the burden … *Corresponding author. Tel: +1 303 436 5498; fax: +1 303 436 7739. E-mail address : fred.masoudi{at}uchsc.edu

Cardiovascular disease and the elderly: can the evidence base avoid irrelevance?