ABSTRACT
Circulatory diseases account for approximately 30% of the 55 million deaths that occur in the world each year, and represent the major cause of mortality in industrialized nations. In the Western world, vascular disease claims two-fifths of all lives lost, the vast majority of these coming from stroke and heart attack. While atherosclerotic coronary occlusion is the most important cause of premature death (especially among men) in Western society, its main impact overall falls on the elderly, and in particular on elderly women (Fig. 12.1).1-3 In fact, more than 80% of those who die from coronary heart disease (CHD) are older than 65. Similarly, strokes affect primarily the elderly and women (see Fig. 12.1). In parallel with this cumulative degenerative pathology in the elderly population come the spectres of physical and mental disability, both of which will increasingly stress the healthcare and social services of industrialized countries. Particular weight needs to be given to the management of cerebral degeneration associated with Alzheimer’s and ischaemic brain disease, and to the maintenance of blood flow through the coronary and peripheral arterial beds. Unfortunately, the extent of these problems, uncertainties over appropriate management strategies, and constraints on healthcare budgets all conspire to limit strategic development and the implementation of workable and affordable policies. This chapter reviews our understanding of coronary and cerebral well-being in the elderly.
