Cholesterol may be a more important risk factor for coronary heart disease in the elderly than previously realized. Lipid-lowering therapies, including diet and drugs, seem to be as effective in the elderly as in the young. However, it may take several years to see a significant decrease in cardiac morbidity and mortality. Therefore, therapy should be reserved for those with a life expectancy of at least ten years. In our experience, diet therapy is difficult for the elderly to follow. Drug therapy is well tolerated, if, as with any other drug, you start low and go slow.