Cardiovascular disease (CVD) in older Americans imposes a huge burden in terms of mortality, morbidity, disability, functional decline, and healthcare costs. In light of the projected growth of the population of older adults over the next several decades, the societal burden attributable to CVD will continue to rise. There is thus an enormous opportunity to foster successful aging and to increase functional life years through expanded efforts aimed at CVD prevention. This chapter provides an overview of the epidemiology of CVD in older adults, including an assessment of the impact of CVD on mortality, morbidity, and health care costs.

Objectives To examine the association between six-minute walk test (6 MWT) performance and all-cause mortality, coronary heart disease mortality, and incident coronary heart disease in older adults. Methods We conducted a time-to-event analysis of 1,665 Cardiovascular Health Study participants with a 6 MWT and without prevalent cardiovascular disease. Results During a mean follow-up of 8 years, there were 305 incident coronary heart disease events, 504 deaths of which 100 were coronary heart disease-related deaths. The 6 MWT performance in the shortest two distance quintiles was associated with increased risk of all-cause mortality (290-338 meters: HR 1.7; 95% CI, 1.2-2.5; <290 meters: HR 2.1; 95% CI, 1.4-3.0). The adjusted risk of coronary heart disease mortality incident events among those with a 6 MWT <290 meters was not significant. Discussion Performance on the 6 MWT is independently associated with all-cause mortality and is of prognostic utility in community-dwelling older adults.

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Objective Rheumatoid arthritis (RA) is associated with an increased cardiovascular (CV) burden similar to that of diabetes mellitus (DM). This risk may warrant pre-operative CV assessment as is performed for patients with DM. We aimed to determine if the risk of perioperative mortality and CV events among patients with RA differed from those of unaffected patients and those with DM. Methods We used 1998 to 2002 Nationwide Inpatient Sample of the Healthcare Cost Utilization Project (HCUP-NIS) data to identify elective hospitalizations of patients undergoing non-cardiac surgery. Surgical procedures were categorized as low risk, intermediate risk, and high risk of CV events using established guidelines. Logistic models provided the adjusted odds of study endpoints in RA, DM, or both relative to neither condition. Results Among 7,756,570 patients with a low risk, intermediate risk, or high risk non-cardiac procedure, 2.34%, 0.51%, and 2.12% had a composite CV event, respectively, and death occurred in 1.47%, 0.50%, 2.59% respectively. Among those with an intermediate risk procedure, death was less likely in RA than DM patients (0.30% vs. 0.65%; p <0.001), but the difference in mortality among those with low risk or high risk procedures was not significant. Patients with RA were less likely to have a CV event than patients with DM with procedures of low risk (3.38% vs. 5.30%; p <0.001) and intermediate risk (0.34% vs. 1.07%; p <0.001). In adjusted models, RA was not independently associated with an increased risk of perioperative mortality or CV event. Conclusions RA was not associated with adverse perioperative CV or mortality risk, suggesting a lack of need for a change from current perioperative clinical care.