Epidemiology and prevention of coronary heart disease in older adults

Coronary heart disease (CHD) is highly prevalent in older adults, affecting 40% of men and 30% of women aged 80 years and over. Among persons aged 75 years and over, 79% of men and 85% of women have hypertension, with intensive blood pressure control showing similar benefit for reduction of cardiovascular outcomes as compared to younger persons; isolated systolic hypertension remains the predominant hypertensive subtype in older persons. Elevated LDL-C remains common in older adults, and meta-analyses of clinical trials to reduce LDL-C show similar benefit in those aged > 75 years compared to 55 mg/dL. About 55% of adults aged 65 years and over have advanced cardiovascular kidney metabolic (CKM) syndrome, emphasizing the need for multifactorial treatments to reduce associated risk factors, including obesity, diabetes or pre-diabetes, dyslipidemia, hypertension, and chronic kidney disease to prevent CHD. Adoption of healthy lifestyle habits and initiation of recommended preventive treatments early in life and in the disease course can help reduce the burden of CHD and its complications with the aging of the patient.