This review article, authored by Marcin Piechocki and colleagues, focuses on the epidemiology, risk factors, and management strategies for non-coronary, peripheral arterial atherosclerotic diseases (PAD) in elderly patients. Atherosclerosis is a progressive disease that increases the risk of ischemic events in organs such as the brain, kidneys, and limbs, leading to reduced life expectancy and quality of life. Despite extensive research on coronary artery disease (CAD) management in the elderly, there is a lack of data and guidelines for managing atherosclerotic lesions outside the coronary territory, particularly in older patients with severe comorbidities or cognitive impairments. The article highlights that aging is a key risk factor for atherosclerosis progression, and cardiovascular disease is the leading cause of death and disability in adults aged 75 and older. The review emphasizes the importance of understanding the prevalence, risk factors, and management strategies for extra-coronary atherosclerotic lesions, especially in elderly patients. Key points include: - Atherosclerosis is a chronic, inflammatory-thrombotic disease that progresses with age, influenced by genetic and environmental factors. - Vascular aging involves the loss of elastic fibers and the replacement with collagen and calcium, leading to vessel stiffening. - Arterial stiffness and compliance are crucial factors in the development and progression of atherosclerosis. - The morphology and dynamics of atherosclerotic lesions differ in different arterial territories, with younger patients showing greater metabolic activity and dynamics. - Family hypercholesterolemia (FH) is a monogenic disorder that significantly increases the risk of premature atherosclerosis, affecting various arterial territories. - Lower extremity PAD is a significant cause of morbidity, with smoking being the greatest modifiable risk factor. - Renal artery stenosis (RAS) is more common in older individuals and is associated with increased mortality and cardiovascular events. The review also discusses the challenges in diagnosing and managing PAD and RAS in elderly patients, including the use of advanced imaging techniques and the importance of comprehensive clinical care. The article concludes by emphasizing the need for more evidence-based guidelines and personalized interventions to improve outcomes in this patient population.This review article, authored by Marcin Piechocki and colleagues, focuses on the epidemiology, risk factors, and management strategies for non-coronary, peripheral arterial atherosclerotic diseases (PAD) in elderly patients. Atherosclerosis is a progressive disease that increases the risk of ischemic events in organs such as the brain, kidneys, and limbs, leading to reduced life expectancy and quality of life. Despite extensive research on coronary artery disease (CAD) management in the elderly, there is a lack of data and guidelines for managing atherosclerotic lesions outside the coronary territory, particularly in older patients with severe comorbidities or cognitive impairments. The article highlights that aging is a key risk factor for atherosclerosis progression, and cardiovascular disease is the leading cause of death and disability in adults aged 75 and older. The review emphasizes the importance of understanding the prevalence, risk factors, and management strategies for extra-coronary atherosclerotic lesions, especially in elderly patients. Key points include: - Atherosclerosis is a chronic, inflammatory-thrombotic disease that progresses with age, influenced by genetic and environmental factors. - Vascular aging involves the loss of elastic fibers and the replacement with collagen and calcium, leading to vessel stiffening. - Arterial stiffness and compliance are crucial factors in the development and progression of atherosclerosis. - The morphology and dynamics of atherosclerotic lesions differ in different arterial territories, with younger patients showing greater metabolic activity and dynamics. - Family hypercholesterolemia (FH) is a monogenic disorder that significantly increases the risk of premature atherosclerosis, affecting various arterial territories. - Lower extremity PAD is a significant cause of morbidity, with smoking being the greatest modifiable risk factor. - Renal artery stenosis (RAS) is more common in older individuals and is associated with increased mortality and cardiovascular events. The review also discusses the challenges in diagnosing and managing PAD and RAS in elderly patients, including the use of advanced imaging techniques and the importance of comprehensive clinical care. The article concludes by emphasizing the need for more evidence-based guidelines and personalized interventions to improve outcomes in this patient population.