Age is an independent and unmodifiable risk factor for coronary atherosclerosis. In Mexico, coronary heart disease is responsible for 50 % of the deaths for those older than 65 years of age. Aging produces major differences in the presentation, diagnosis, prognosis, and response to therapy in coronary heart disease. The goal of treatment is the prolongation of survival and the improvement of the quality of life. However, in the elderly, the aim of therapy should focus on attaining a meaningful quality of life thus allowing them to be functionally independent. Clinical trials demonstrate conclusively that lowering serum cholesterol levels will reduce the incidence of coronary heart disease irrespective of age. Dietary advise and life-style modifications are the first-line approach in the elderly. When these measures are insufficient to achieve target lipid reductions, statins are the drug of choice. Fibrates may be indicated if triglycerides are high and C-HDL is low. Given the grater coronary risk of older population, the absolute benefit will be greater in the elderly.