Secondary Prevention of Coronary Heart Disease in the Elderly (With Emphasis on Patients ≥75 Years of Age)

The overall aging of the American population and improving survival of patients with coronary heart disease (CHD) has created a large population of older adults (>=65 years of age) eligible for secondary prevention. The prevalence of chronic ischemic heart disease in men and women >=65 years of age in the United States in 1995 was 83 per 1000 men and 90 per 1000 women. Among those >=75 years of age, the prevalences were 217 per 1000 for men and 129 per 1000 for women.1 Increasing evidence has accumulated over the past 2 decades that elderly individuals with CHD can benefit greatly from exercise training and other aspects of secondary prevention. Traditionally, components of secondary prevention programming (including exercise; smoking cessation; management of dyslipidemia, hypertension, diabetes, and weight; and interventions directed at depression, social isolation, return to work, and other psychosocial issues) have been provided by the clinician in the office setting or through cardiac rehabilitation programs. Cardiac rehabilitation programs are particularly well suited to the provision of secondary prevention services, but unfortunately, many older patients who would derive benefit from these interventions do not participate because of lack of referral or a variety of societal and other barriers.3 It is the purpose of this Scientific Statement to provide an update on the benefits of specific secondary prevention risk factor interventions in this age group and, where possible, to delineate benefits in the older elderly (>=75 years of age). An increased awareness on the part of physicians, nurses, third-party payers, and patients and their families of the benefits of secondary prevention programs to older adults will provide a basis for referral and aid in the implementation of such programming.