ABSTRACT
Coronary atherosclerosis is very common in the elderly population, with autopsy studies demonstrating a prevalence of at least 70% in persons over age 70. Prevalence and extent of coronary heart disease (CHD) increase with age. In the Coronary Artery Surgery Study, the prevalence of three-vessel CHD was 61% in patients aged 65 years and older versus 46% in those younger than 65 years; left main coronary artery stenosis was seen in 13% versus 9%, respectively. Coronary artery calcium is also more common in the elderly than in younger populations. Exertional angina pectoris caused by myocardial ischemia is commonly the first manifestation of CHD in young and middle-aged persons. It is usually easily recognized because of its typical features; however, in the elderly, this may not be the case. In other elderly individuals, myocardial ischemia is manifested clinically as frank heart failure, with some patients presenting with acute pulmonary edema.
