Old age brings some physiological changes in the cardiovascular system which increase the chances of Coronary heart disease (CHD) in the elderly. The prevalence of some of these classic risk factors is lower in the Indo-Asian community, they vary greatly within this population and do not provide a plausible explanation for the increased incidence of CHD. The high incidence of CHD in Indo-Asians could not be explained purely on the basis of conventional risk factors such as hypertension, smoking and total cholesterol concentration. In the Indo-Asian population, insulin resistance syndrome may provide some clues to the deranged metabolic profile. Inflammation, infection and endothelial functions are being explored in an attempt to clarify the increased incidence for CHD in Indo-Asians. Medications offer functional independence, improved quality of life and enhanced life expectancy in cardiovascular disease. Innovations in the field of cardiovascular surgery and anaesthesia mean that a significant number of elderly patients can now be considered for coronary artery bypass graft.