Objective To examine target attainment of lipid-lowering, antihypertensive and antidiabetic treatment in the elderly in a specialist set-ting of a University Hospital in Greece. Methods This was a retrospective study including consecutive subjects≥65 years old (n=465) with a follow-up ≥ 3 years. Low-density lipoprotein cholesterol (LDL-C), blood pressure (BP) and glycated hemoglobin (HbA1c) goal achievement were recorded according to European Society of Cardiology/European Atherosclerosis Society (ESC/EAS), European Society of Hypertension (ESH)/ESC and European Association for the Study of Diabetes (EASD) guidelines. Results The LDL-C targets were attained by 27%, 48%and 62%of very high, high and moderate risk patients, respectively. Those receiving statin+ezetimibe achieved higher rates of LDL-C goal achievement compared with those receiving statin monotherapy (48%vs. 33%, P<0.05). Of the diabetic sub-jects, 71%had BP<140/85 mmHg, while 78%of those without diabetes had BP<140/90 mmHg. A higher proportion of the non-diabetic individuals (86%) had BP<150/90 mmHg. Also, a higher proportion of those with diabetes had HbA1c<8%rather than<7%(88%and 47%, respectively). Of note, almost one out of three non-diabetic individuals and one out of ten diabetic individuals had achieved all three treatment targets. Conclusions Even in a specialist setting of a University Hospital, a high proportion of the elderly remain at suboptimal LDL-C, BP and HbA1c levels. The use of drug combinations could improve multifactorial treatment target attainment, while less strict tar-gets could be more easily achieved in this population.