Statins should be given to octogenarians for primary prevention of coronary heart disease. There is a substantial burden of disease and disability in this population that statin treatment can address in an effective manner. It has been shown that statin treatment is both effective and safe, and details of the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) trial are reviewed. It may be useful to tease out those at particularly high risk who would benefit from statin treatment. In this regard, a low high-density lipoprotein cholesterol level, high-sensitivity C-reactive protein level, and subclinical measures of atherosclerosis may be particularly useful.