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Elevated LDL\u2010cholesterol and non\u2010HDL\u2010cholesterol levels remain predictive of incident atherosclerotic cardiovascular events among individuals older than 75\u2009years. Risk prediction among older individuals is less certain because most current risk calculators lack specificity in those older than 75\u2009years and do not adjust for co\u2010morbidities, functional status, frailty, and cognition which significantly impact prognosis in this age group. Data on the benefits and risks of lowering LDL\u2010cholesterol with statins in older patients without atherosclerotic cardiovascular disease are also limited since most primary prevention trials have included mostly younger patients. Available data suggest that statin therapy in older primary prevention patients may reduce atherosclerotic cardiovascular events and that benefits from lipid\u2010lowering with statins outweigh potential risks such as statin\u2010associated muscle symptoms and incident Type 2 diabetes mellitus. While some evidence suggests the possibility that statins may be associated with incident cognitive impairment in older adults, a preponderance of literature indicates neutral or even protective statin\u2010related cognitive effects. Shared decision\u2010making which is recommended for all patients when considering statin therapy is particularly important in older patients. Randomized clinical trial data evaluating the use of non\u2010statin lipid\u2010lowering therapy in older patients are sparse. Deprescribing of lipid\u2010lowering agents may be appropriate for select patients older than 75\u2009years with life\u2010limiting diseases. Finally, a patient\u2010centered approach should be taken when considering primary prevention strategies for older adults.<\/jats:p>","DOI":"10.1111\/jgs.19398","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T08:01:29Z","timestamp":1744272089000},"page":"1674-1696","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Managing Hypercholesterolemia in Adults Older Than 75\u2009years Without a History of Atherosclerotic Cardiovascular Disease: An Expert Clinical Consensus From the National Lipid Association and the American Geriatrics Society"],"prefix":"10.1111","volume":"73","author":[{"given":"Vera","family":"Bittner","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Disease University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunny A.","family":"Linnebur","sequence":"additional","affiliation":[{"name":"University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave L.","family":"Dixon","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy &amp; 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