The recent Perindopril and Remodeling in the Elderly with Acute Myocardial Infarction (PREAMI) trial was the first to study elderly patients (average age 73 years) with acute small myocardial infarcts (MI) and normal cardiac function. It showed that left ventricular (LV) volumes remained stable in the group treated with the angiotensin-converting enzyme inhibitor perindopril. Several small studies in the ischemic or post-MI setting show that cytokine and oxygen radical activation and apoptosis are all more pronounced in aging as compared to young hearts. Such mechanisms aid the remodeling process. Additional contributory factors in the aging heart include increased wall stress, LV hypertrophy, and myocardial stiffness. When combined with the PREAMI results, these observations suggest that post-MI remodeling is indeed different in the elderly...