Although HMG-CoA reductase inhibitors (statins) have been shown to reduce the risk of cardiovascular events in patients aged 65-80 years who have clinical cardiovascular disease, fewer data are available for elderly patients without cardiovascular disease. Treatment guidelines recommend a low-density lipoprotein cholesterol goal of <100 mg/dL for those with cardiovascular disease or diabetes mellitus but vary in their recommendations for primary prevention. Moderate-dose statins have been shown to be effective and safe in properly selected elderly patients up to the age of 80 years. High-dose statins have also been shown to be effective and reasonably safe in patients without significant co-morbidities up to the age of 75 years. With advancing age, the potential for benefit from cholesterol-lowering treatment needs to be weighed against the increasing risk of muscle and hepatic toxicity, as well as competing causes of morbidity and mortality.