Epidemiology of cardiovascular risk factors in older age

Cardiovascular diseases represent the main cause of disability and mortality, as well as the main determinant of resource consumption, among older populations. Due to several factors, including increased non-cardiovascular mortality, atypical presentation of coronary events, selective survival, and, possibly, clustering of protective genetic traits - the relative risk associated with almost all of risk factors decreases with advancing age. Nonetheless, all available evidence from both observational studies and randomized trial indicates that, due to the higher event rates, the absolute risk reduction yielded by preventive interventions is much greater in the older age segments of populations. As a whole, the complex interrelationships of cardiovascular risk factors in older age seem to account for the more favorable cost-effectiveness ratios of preventive interventions in older, as compared with middle-aged subjects. On the other hand, the high level of interaction between coexistent risk factors and comorbidity renders a global approach to the prevention of cardiovascular events in older subjects mandatory for physicians, as well as for decision-makers. In fact, multidimensional assessment - including the evaluations of cognitive, affective, and social issues, and driving a multidisciplinary treatment of risk factors - is a key factor to ensure patients' compliance and to significantly reduce the burden of disability, morbidity, and mortality imposed by cardiovascular diseases to western older population.