To assess the relationship between serum lipids and coronary heart disease (CHD) in an elderly population (mean age = 77.4; SEM +/- 0.4; range 70-92 years), serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured in 84 (males = 52) subjects with evidence of definite myocardial infarction and 125 (males = 77) age- and sex-matched controls free of CHD on Rose questionnaire and resting electrocardiogram. On multivariate logistic regression analysis, CHD showed inverse association with HDL-C (odds ratio for decrease by 1 s.d. = 1.6, P = 0.02) in males and positive association with TC (odds ratio for increase by 1 s.d. = 1.8, P = 0.03) and LDL-C (odds ratio for increase by 1 s.d. = 1.8, P = 0.04) in females. Of the other variables only diabetes in males (odds ratio 2.4, P = 0.05) and left ventricular hypertrophy in females (odds ratio 8.8, P = 0.03) were associated with CHD. The results suggest that further prospective studies to further evaluate the relation of serum lipids with CHD in this age group are indicated.