Cardiovascular risk-factor reduction in elderly patients with cardiac disease

As a result of increased numbers of elderly persons in the United States, many of whom have coronary heart disease, the mean age of patients in coronary care programs following a myocardial infarction is now greater than age 65 years. One third of cardiac operations on adults are performed on elderly patients. Despite the fact that in the United States utilization of interventions such as coronary artery bypass grafting and angioplasty is on the rise in elderly patients, there appears to be some reluctance to manage risk factors in this group. The four major modifiable risk factors for the development and progression of coronary artery disease are hypertension, hypercholesterolemia, habitual smoking, and physical inactivity. The effectiveness of risk-factor modification for the secondary prevention of events of cardiac morbidity and mortality has been described for younger persons; however, less is known for elderly persons. The purpose of this review is to focus on these four major risk factors in elderly patients with cardiac disease by describing the effectiveness of modification of these factors, methods for doing so, and considerations for the future of such interventions.