Cardio-vascular diseases are a major contributor to mortality, morbidity and functional decline in the elderly population. Hypercholesterolemia remains a major risk factor in older persons, but treatment decisions are difficult because of the paucity of data specific to this segment of the population. While evidence seems strong enough to support treating patients with cardio-vascular diseases (secondary prevention) up to their eighties, the question remains open whether to treat asymptomatic older patients (primary prevention) or those in their nineties.