This chapter attempts to outline the complexity in treating older persons with risk factors for cardiovascular and/or cerebrovascular disease, with particular emphasis on hyperlipidemia. Adverse effects of many drugs may increase an individual’s risk of falls. Combinations of any of these agents will further increase risk plus environmental factors. A number of studies report that in older adults, high cholesterol levels pose a significant risk for death from coronary artery disease, while some others have suggested that lowering cholesterol levels in older persons may increase the risk for stroke or heart attack. The Cox-2 inhibitors may elicit a similar range of adverse reactions to the traditional nonsteroidal antiinflammatory drugs and also increase the risk of cardiovascular disease. The antibiotic combination, trimethoprim/sulfamethoxazole, has been associated with an increased risk of serious adverse reactions in older people, including bone marrow depression and serious skin reactions and unless there are no other alternatives, it should not be used in older persons.