ABSTRACT
INTRODUCTION Coronary heart disease (CHD) is very common in the elderly population, with autopsy studies demonstrating a prevalence of at least 70% in persons over the age of 70 years (1,2). These autopsy findings may be coincidental, with the disease clinically silent throughout the person’s life; however, only 15-30% of persons over the age of 65 years show clinical manifestations of CHD. In the National Health and Nutrition Examination Survey (NHANES) 2005-2008, the prevalence of clinical CHD rose progressively with age, reaching 35.5% in men and 20.8% in women aged 80 years and above (3). Clinical CHD was present in 502 of 1160 men (43%) of mean age 80 years, and in 1019 of 2464 women (41%), of mean age 81 years in a long-term care facility (4). The marked discrepancy between the clinical and autopsy prevalence of CHD in the elderly indicates that CHD is often silent in this age group. Studies employing exercise testing and myocardial perfusion imaging in asymptomatic volunteers have demonstrated a striking age-related increase in silent myocardial ischemia, helping to reconcile differences in CHD prevalence between clinical and autopsy studies (5).
