Coronary heart disease is currently the first cause of heart disease hospitalization and death among the elderly in China, and its morbidity and mortality are on the rise. Older people mostly suffer from multiple diseases at the same time and need to apply multiple drugs, which are prone to drug interactions; while the tissue structure and physiological function of each organ are degenerative changes, especially the decline of liver and kidney function, the absorption, distribution, metabolism and excretion of drugs, as well as the responsiveness, sensitivity and tolerance of drugs are different from other people; due to the influence of underlying diseases, older patients with coronary heart disease are prone to The risk of interventional and surgical procedures increases significantly. All these factors make the diagnosis and treatment of coronary artery disease in the elderly more complicated. The symptoms of acute ischemia include shortness of breath, dyspnea, nausea, vomiting, fatigue, syncope and other non-painful symptoms. Due to changes in pain perception and ischemic threshold, the location and nature of pain in myocardial infarction are atypical, sometimes manifesting as epigastric pain with nausea and vomiting, and also occurring in the head and neck, jaw, and toothache. In elderly patients with acute coronary syndrome (ACS), mild pain, impaired cognition, and other clinical comorbidities often lead to delayed consultation and admission, and in the case of old myocardial infarction and cardiac conduction abnormalities, atypical electrocardiographic changes make diagnosis difficult. Acute exacerbation of coronary artery disease in the elderly often occurs when the clinical picture changes in other acute or comorbid diseases, such as pneumonia, chronic obstructive pulmonary disease and hip fracture resulting in increased myocardial oxygen consumption or hemodynamic abnormalities. Painless myocardial ischemia (SMI) and painless myocardial infarction are important features of coronary artery disease in the elderly, and SMI is closely related to age, with a high frequency of episodes in older patients, especially in elderly patients with coronary artery disease combined with hypertension and diabetes. In elderly patients with coronary artery disease combined with hypertension and type 2 diabetes, coronary artery perfusion is further reduced when the heart rate decreases significantly, especially at night, because of their poor vegetative regulation, while increased myocardial oxygen consumption is not the main cause of their morbidity. The detection rate of myocardial ischemia in elderly patients with coronary artery disease is low in conventional ECG, but the detection rate of SMI in dynamic ECG is higher. Dynamic ECG can observe myocardial ischemia more accurately and dynamically, especially the detection rate of transient myocardial ischemia is higher, which can make up for the shortage of conventional ECG and reduce the missed diagnosis. For elderly patients with atypical symptoms, history, physical examination, ECG and laboratory tests complement each other, and the detection of serum troponin (cTNI and cTNT) and brain natriuretic protein (BNP) can help to screen for ACS in the elderly. 2. Pharmacological treatment of elderly patients with coronary artery disease Several common conditions in the pharmacological treatment of elderly patients with coronary artery disease, such as inadequate treatment of the elderly, overdose and coexistence of multisystem disease treatment, often make treatment tricky. Although the incidence of side effects, interactions and adverse events of multiple cardiovascular drug combinations do not differ between the elderly and the young, the physical vulnerability of elderly patients should be recognized, and for the elderly, starting with small doses and increasing them slowly is recommended. It is also important to enhance patient education, improve patient compliance, early identification of complications, and early recognition of drug side effects. Most elderly patients can tolerate long-term low-dose aspirin, and loading doses of aspirin and clopidogrel in ACS. Combined atrial fibrillation is not uncommon in elderly patients with coronary artery disease. In patients at high risk for embolism and stroke, the need for combination therapy with warfarin anticoagulation increases the risk of bleeding and may be considered to control INR to a lower level. There is no conclusive evidence for the interaction of clopidogrel with proton pump inhibitors and it is currently considered that in patients with peptic ulcers and bleeding, they can be used together. Statin therapy is effective in reducing cardiovascular events in patients at high risk for acute coronary syndromes and coronary heart disease and can be used safely and effectively in most people under 80 years of age. Therefore, active use of statins in older adults with indications should be encouraged. Evidence of benefit from statin use in older adults is still insufficient, and evidence-based medical evidence for intensive lipid-lowering therapy in low-risk older patients is lacking. Treatment targets LDL-C in high-risk patients with coronary artery disease .