10.4. Conclusions

CHD is common in elderly Finns. The total prevalence of CHD, including AP, MI, coronary artery bypass operation or angioplasty or ischaemic ECG findings, is 38% in men and 42% in women, aged 64 – 97 years. The prevalence of CHD is higher than that of the clinical manifestations, although it is possible that the prevalence of CHD was overestimated in the study population. Ischaemic ECG findings, especially minor ones, were common in this elderly population. Undiagnosed MIs were common especially among women with diabetes.

CHD seems to be less severe in elderly women than men. More men than women have suffered a MI (14% vs. 7%) or a MI with a major Q wave (4% vs. 1%). This may in part be due to the fact that the majority of men are current or ex-smokers, whereas the majority of women have never smoked.

The clinical picture of CHD varied in this elderly population. Some patients had no symptoms, while some had chest pain and/or dyspnoea. More male than female patients suffered from typical AP (9% vs. 5%). Atypical chest pain with ischaemic ECG changes is common, especially among women. Minor ECG changes especially in the ST and T segments are common with ageing, but these findings, combined with atypical chest pain or dyspnoea, may suggest the possibility of CHD. Atrial fibrillation, heart enlargement in chest x-ray, hypertension and severe dyspnoea are more common in male and female persons with CHD than in persons without it. Diabetes is also more common in male persons with than without CHD.

Elderly CHD patients have more limited functional abilities than matched controls, which may be due to the symptoms of the disease. Especially male patients" physical limitations may be partly due to the fact that men with CHD are more likely to be depressed. Although no independent association between physical disability and CHD was found, the associations that emerged between physical disability and the use of cardiovascular medication probably imply a causal relationship between CHD and physical disability.

Depression is common among patients with CHD. The symptoms of depression may be masked behind the somatic symptoms of severe illness. More attention should be given to the recognition and treatment of CHD patient"s depression. It seems that CHD is not an independent factor in the etiology of depression among the elderly, but that physical disability and psychosocial factors contribute as well. The association of CHD with depression among men is explained by the acute or chronic psychic stress caused by CHD. It may be that the more complicated the patient"s CHD, the more probable is the presence of depression.

In general, cognitive impairment is equally common among elderly ambulatory CHD patients and elderly subjects without CHD. The relative contribution of CHD to the occurrence of cognitive impairment among aged non-institutionalized persons is none or minimal.

CHD has no major impact on community-dwelling patients" social functioning. Severe CHD is related to decreased social functioning, though younger patients, in spite of their chest pain, are capable of social participation. At least among male CHD patients with a lowered social participation rate, CHD and other factors, such as physical disability, higher age and other chronic diseases, are contributors.