Coronary heart disease remains the leading cause of morbidity and mortality in older adults, despite improved survival and declining mortality. This article describes the prevalence and impact of heart disease on people's lives, singly and in combination with other diseases. It then reviews current findings as to the risk factors for CHD in older adults and the underlying physiologic changes of aging plus pathophysiologic changes of hypertension and CHD in impairing the ability of older adults to respond to exercise and other stressors, and the effects of exercise training in attenuating the adverse cardiovascular changes of aging. This information provides a basis for considering opportunities for prevention of heart disease and maximizing heart function. The article concludes by describing the known contribution of preventive measures to declines in heart disease in older adults.