Current concepts of cardiovascular disease pathophysiology include a prominent role for thrombosis as a key factor. Thrombosis is not only the usual precipitant to a clinical event, but it may also be involved in atherosclerotic plaque development throughout most of the adult years. However, our understanding of thrombotic risk factors, especially in the elderly, is poor and research has just begun in this area. Fibrinogen has been clearly established as an independent risk factor in the middle aged, but there are conflicting data concerning older persons. Factor VII and plasminogen activator inhibitor-1 look promising as risk factors in the middle aged, but there are no data currently available concerning the status of these factors in the elderly. Many associations exist between the thrombotic risk factors and other cardiovascular risk factors such as plasma lipids and glucose intolerance, making the establishment of independence difficult, and little is known about how these different factors may interact in older individuals. Ongoing studies should provide many answers in the near future.