Cardiovascular Disease in the Elderly

The proportion of people aged 65 years or older in Korea is projected to increase from 7.3 percent of the population in 2000 to 15.1 percent in 2020. Cardiovascular disease is the most frequent diagnosis and the leading cause of death in the elderly. Hypertension occurs in one-half to two-thirds of people older than 65 years, and heart failure is the most frequent diagnosis on discharge in elderly patients. The blood pressure in elderly individuals differs from that in young individuals. The systolic pressure increases until 80 years of age, whereas the diastolic pressure rises until around 55, when it levels off or down. Systolic hypertension is a stronger predictor of cardiovascular events. The characteristic findings of blood pressure in the elderly are isolated systolic hypertension, postural hypotension, pseudohypertension and postprandial hypotension. Heart failure with preserved systolic function is more common in old ages. Coronary artery disease is more likely to involve multiple vessels and the left main coronary artery. Angina symptoms are more likely to be absent, or atypical in older patients. Thiazide diuretics are recommended as the first-line treatment of hypertension in elderly patients. There is increasing experience of both percutaneous coronary intervention and coronary artery bypass grafting in older patients. Atrial fibrillation is seen in 10 percent of elderly patients, and they should be on anticoagulation to prevent stroke.