Cardiovascular morbidity is the leading cause of mortality in the developed nations. Elevated serum cholesterol is a major risk factor for ischemic heart disease, one of the common cardiovascular morbidity in older adults, statins have been shown to be effective in reducing serum cholesterol and improving outcomes. Hypercholesterolemia is common in older adults and is one of the major modifiable risk factors. Yet, these patients have often been excluded from major clinical trials of statins and evidence suggests of their underuse. Data from recent clinical trials of statins indicate that the elderly patients with the highest cardiovascular risk are likely to derive the most benefits from cholesterol lowering. With the aging of the population, the prevalence of hypercholesterolemia and cardiovascular morbidity is likely to increase. In this review we evaluate the evidence for the use of statins in older adults. © 2008 Elsevier Ireland Ltd. All rights reserved.