Atherosclerosis associated diseases are the major cause of mortality in men and women over 65 years. Although the epidemiological relationship between hypercholesterolemia and cardiovascular disease is less prominent in elderly than in younger patients, the results of numerous intervention trials show that risk reduction can also be achieved in elderly and old patients. The numbers needed to treat to prevent one cardiovascular event is usually lower in this age group because of the high absolute rate of events. Therefore, in secondary prevention settings these patients should be treated similar to younger patients, i.e. a LDL-cholesterol below 100 mg/dl should be achieved. In hyper- or dyslipoproteinemic patients without evidence of clinical or subclinical atherosclerosis cholesterol lowering drugs should be used restrictively.