Cardiovascular disease is the leading cause of morbidity and mortality in the USA, and its prevalence increases with age. Hypercholesterolemia is a major cause of coronary heart disease, in particular in older adults. Clinical trials have shown that statin therapy to decrease low-density lipoprotein cholesterol levels lowers cardiovascular events and mortality. There is evidence, albeit limited, that older subjects show benefit similar to that in younger subjects. Nevertheless, the use of medication must be approached judiciously in the elderly. Benefits should clearly outweigh the risk of adverse effects. Lifestyle changes (heart-healthy diet and regular aerobic exercise) remain the first-line of therapy for primary prevention in older adults. However, drug therapy should be considered in patients with multiple risk factors and in those with established coronary heart disease...