There are limited data regarding the diagnosis and treatment of hypercholesterolemia in elderly patients with acute myocardial infarction (AMI). The authors describe the inhospital and discharge prescription patterns of lipid-lowering agents in patients hospitalized with an AMI, and identify factors associated with low rates of utilization of these therapies. The authors analyzed the Minnesota Heart Survey, a population-based surveillance project that retrospectively abstracted the medical records of patients hospitalized with AMI in 2001-2002 from 21 hospitals in the Minneapolis-St Paul metropolitan area. They identified 2773 patients 30 years and older with an AMI. The mean total cholesterol was 175 ± 45 mg/dL, the mean low-density lipoprotein cholesterol was 104 ± 38 mg/dL, and the mean high-density lipoprotein cholesterol was 44 ± 14 mg/dL. Statins were prescribed at discharge to 74.6%, 63.2%, and 38.5% of patients younger than 65, 65-74, and 75 years and older, respectively (P < .0001). The utilization of statins was highly correlated with the administration of other standard AMI therapies - aspirin, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and reperfusion therapy - and was more prevalent among patients undergoing percutaneous coronary intervention than among those undergoing coronary artery bypass surgery. Elderly patients remain less likely to receive lipid-lowering therapy following an AMI. Greater attention is required to ensure that elderly AMI patients without contraindications are appropriately treated with lipid-lowering therapy.