Cardiovascular disease is the leading cause of death in men and women older than 65 years; therefore, its prevention is an important public health priority. Although cardiovascular risk is multifactorial, elevated low-density lipoprotein cholesterol levels contribute to risk even in old age. Despite the importance of lowering low-density lipoprotein cholesterol with statins to reduce cardiovascular events, specific evidence and recommendations for older populations are limited. Where evidence supports lipid lowering in older adults, provider and patient adherence to statins remains suboptimal. Paradoxically, risk is an inverse driver of statin use regardless of age, with those most likely to benefit being least likely to receive them. Reconsidering evidence around, use of statins as well as ways to optimize the prescription of statins and adherence in appropriately selected older adults is warranted.