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See related article, pages 441–450. In this issue of Stroke , Robinson et al provide a thoughtful, logical, and concise review of the rationale for and clinical trial design of a primary cardiovascular disease prevention study in the elderly.1 As the authors point out, cardiovascular diseases are the leading cause of death and disability in the elderly who reside in developed countries. Yet, there is a paucity of evidence-based data from which to guide us in determining which medical interventions, such as statin and blood pressure-lowering therapies, to use among those ≥70 years of age. With diabetes mellitus incidence and mortality on the rise and as a significant concern in many parts of the world,2 and stroke mortality a prevalent problem in developing countries,3 this is not a time to be complacent about cardiovascular disease and, specifically, stroke prevention. Stroke incidence rises exponentially with age and has become an increasingly important cause of mortality and morbidity in the community as heart disease mortality has continued to drop steeply over time, and there are more elderly at risk.2 The Oxford Vascular Study places the importance of stroke in a community context by showing that of 2024 acute vascular events in this population during the time period 2002 to 2005, 45% were cerebrovascular (618 stroke, 300 transient ischemic attack) and 42% were coronary vascular (159 ST-elevation myocardial infarction, 316 non-ST-segment myocardial infarction, 218 unstable angina, and 163 sudden cardiac death).4 Furthermore, event and incidence rates rose steeply with age in …

Uncertainty of Management of Blood Pressure and Lipids in the Elderly