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 (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 age 65 show clinical manifestations of
coronary heart disease (CHD). In the National Health and Nutrition Examination Survey
(NHANES) 1999-2002, the prevalence of clinical CHD rose progressively with age,
reaching 18.6% in men and 16.1% in women aged 75 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).
