Aging is associated with progressive increases in plasma triglyceride, total cholesterol, and high-density lipoprotein cholesterol levels. In the general population, total cholesterol correlates directly and high-density lipoprotein cholesterol correlates inversely with the risk of coronary artery disease. In the elderly, similar correlations between serum lipids and coronary risk also exist but are less powerful than in younger subjects. The mechanisms of the plasma lipid alterations and the current guidelines for their management in the elderly are presented.