Primary prevention of cardiovascular disease in older people

Cardiovascular disease is the leading cause of death, morbidity and disability in older people. Strategies for cardiovascular disease prevention and intervention in older people are similar to those available for younger ages. The population strategy for primary prevention is broad ranging from food and tobacco policy legislation and media communication to simple and direct advice delivered by all health workers. High risk strategies for reducing elevated levels of the major cardiovascular risk factors such as hypertension and hypercholesterolemia in older populations indicate that gains in life expectancy are greatest where absolute risk is highest and the intervention is the cheapest available. Non-pharmacological treatment, in particular dietary therapy, is recommended as the first line of treatment for both raised blood pressure and blood cholesterol. Because of the high excess mortality associated with smoking, even a brief advice package associated with modest success is cost effective in older people. Health policy for older people should be directed towards the overall goal of maintenance of autonomy and should include prevention, treatment and rehabilitation of cardiovascular disease as part of a comprehensive program for the prevention and control of all diseases.