Heart in the elderly (views and considerations at the turn of the centuries).

: The proportion of elderly people grows rapidly both in Croatia and worldwide, posing great health care, psychological, social, economic and other problems. In the elderly, cardiovascular diseases, especially coronary (ischemic) heart diseases, account for approximately 50% of all deaths. In contrast to previous opinions, recent studies show that aging per se does not substantially diminish the efficacy of heart pump unless affected by diseases, primarily atherosclerosis (atherothrombosis). Atherosclerosis, however, is not an inevitable component of old age, but a disease that can to a great extent be prevented, and hopefully even defeated in the near future. Of paramount importance is elimination of the major risk factors: cigarette smoking, hypertension, hyperlipidemia, diabetes mellitus, obesity, and physical inactivity, preferably in the form of primary prevention, primarily by the hygienic-dietetic measures, and by medication (antihypertensives, hypolipidemics), if necessary. The prevention should be initiated early enough to prevent the development of subclinical forms of the disease, because clinical manifestations (angina pectoris, myocardial infarction, serious ventricular arrhythmias, sudden death) occurring unexpectedly ('like a bolt from the blue') reflect a very advanced coronary disease. The management of these late complications, however admirable it may be (coronary dilatation--stents, coronary surgery, thrombolysis, resuscitation, electrotherapy, etc.), is only partially successful and in fact unavailable to the majority of the population, even in developed countries. Therefore, every individual should be informed about the main characteristics of the issue to be able to take active participation in the programs of primary prevention. Although the relative importance of particular risk factors decreases in old age, these factors are present in a higher number in the elderly which, along with the generally greater mortality rate, points to the need of all measures (primary and secondary) of prevention to be as carefully carried out in the elderly as in younger individuals.