The aging process of an organism is a complex process that depends on genetic, metabolic, hormonal, immunological, and structural conditions. The disease of an older person can accordingly be influenced by the physiological aging process, but also by intermittent noxae, i.e., diseases in younger life, lifestyle habits, or exogenous toxic causes. Older people are often underrepresented in cardiovascular therapy studies; accordingly, there is often limited evidence and greater uncertainty for the application of drug and interventional therapies in old age. Advances in interventional cardiology have made many heart diseases in the elderly treatable by minimally invasive methods with acceptable risk, but the frailty and multimorbidity of an increasingly old and very old population will pose one of the greatest medical, ethical, and economic challenges for the future of health systems in industrialized countries.