Coronary heart disease in the elderly

In 1984, 435,759 deaths were attributed to CHD among persone ≥65 years of age. CHD was the leading cause of death in this group. Death rates rose steeply with age among the elderly. Men had higher death rates than women, but the male-to-female ratio declined with increasing age. Considerable geographic variation in CHD mortality in the elderly was noted. Since 1968, CHD death rates have declined in persons ≥65 years of age in each age, sex, and race group. However, prevalence of self-reported CHD in the elderly population has increased. Prevalence rates increased with age except for a slight decrease above age 75 in men. In 1985, 436,000 persons aged ≥65 years were discharged with a principal diagnosis of acute MI. The hospital case fatality rate was 21.8%. Since 1970, hospitalization rates for acute MI have generally increased, while hospital fatality rates have decreased for persons ≥65 years of age. Since 1979, utilization of coronary artery bypass surgery and coronary arteriography have dramatically increased among the elderly. In 1980 and 1981, elderly persons made six million visits to physicians' offices for chronic CHD. CHD contributed importantly to the 1980 expenditures of 3.3 billion dollars in men and 4.8 billion dollars in women ≥65 years of age for heart disease care. Although mortality rates from CHD in the elderly have decreased since 1968, increasing hospitalization rates and utilization of other health care services emphasize the need for more vigorous efforts at prevention. Risk factors for development of CHD in the elderly have been identified. Surveys indicate that the prevalence of these risk factors is high in this population. High blood pressure, high blood cholesterol, obesity, and cigarette smoking are modifiable risk factors that may be controlled in the elderly. Prevention and management of CHD in black patients requires vigorous efforts at risk factor reduction and may require the use of tests with high sensitivity and specificity such as echocardiography and coronary arteriography in symptomatic patients.