The progressive aging of the general population is associated with a parallel increment of cardiovascular diseases which are the main cause of death and morbidity in the elderly. Quality of life in elderly patients with ischemic heart disease is one of the most important objectives of medical practice. In the clinical management of elderly coronary patients it must be taken into account not just the general clinical conditions and the presence of comorbidities, but also the impact of therapy on life expectancy and quality of life. Revascularization should be reserved to those patients with refractory angina despite maximal medical therapy and to those in whom angina compromises the quality of life. Conventional antianginal therapy consists mainly in the administration of drugs with hemodynamic mechanisms that in elderly patients may be associated with a higher incidence of significant adverse effects that are dependent not only upon their hemodynamic action but also on altered pharmacokinetics. Adjunctive therapy with metabolic agents, such as trimetazidine, to standard care of elderly patients with ischemic heart disease may be particularly useful in the treatment of angina. The improvement in cardiac global performance, seen with adjunctive trimetazidine, is associated with a reduction in symptoms and with an improvement in functional capacity and quality of life.