Aging is accompanied by increases in cholesterol levels that increase the risk of atherosclerosis, coronary heart disease, and stroke. A large body of evidence shows that lipid lowering can reduce the incidence of vascular-related events. Guidelines for the management of hypercholesterolemia were outlined in the second National Cholesterol Education Program report (Adult Treatment Panel II). According to ATPII, the first step is to identify individuals at risk for vascular disease and those with borderline-high or high cholesterol levels. Screening for hyperlipidemia should continue beyond age 65 if the individual patient would benefit from long-term lipid management. Primary and secondary interventions consist of dietary therapy, exercise, and pharmacotherapy, based on the individual patient's risk factors.