The "graying of America" is resulting in an exponential increase in the number of very elderly patients presenting with cardiovascular disease. Despite the availability of many effective cardiovascular therapeutics, elderly cardiac patients are treated less aggressively and receive less evidence-based care. This phenomenon can be attributed to factors that include underrepresentation of older patients in clinical trials, age-related treatment biases, and potential reluctance of the elderly to consider aggressive treatment. All these factors are remediable. Action to increase evidence-based use of treatments in the elderly should result in both the prolongation of life and compaction of morbidity in our growing elderly population. Inaction will surely result in increased health burdens for these patients and on society as a whole. Therefore, although treatments must continue to be applied to individuals based on their preferences, the evidence for these treatments must not summarily discriminate on the basis of age.