Objective: To evaluate plasmatic lipid levels in elderly women in the general population as a function of use of lipid lowering agents (LLA) and hormone therapy (HT) Methods: 4271 women over 65 were recruited from three French cities. Analyses were performed after stratification by LLA treatment and HT and adjusting for a large range of socio-demographic and clinical factors. Results: Fifteen percent of women currently used HT (78% transdermal estradiol), and 30% were taking LLA. In this population, 4.6% of women were taking both HT and LLA (fibrate for 2.4% and statin for 2.2%). In non-LLA treated women, current HT was associated with lower total cholesterol, LDL-C, and non-HDL-C compared to never users. Women treated with LLA, also had lower total cholesterol, LDL-C, and non-HDL-C compared to non-LLA users, whereas triglyceride levels were the highest in statin users and lowest in fibrate users. Fibrate was associated with a more favorable lipid pattern than statin independently of HT use. In women without coronary heart disease or diabetes HT, statin, or fibrate were associated with lower LDL-C level risk based on NCEP guidelines (adjusted OR=0.67 [IC95=0.53;0.85], 0.38 [0.29;0.47], and 0.32 [0.25;0.42], respectively) with a possible interaction between fibrate and HT (0.18 [0.10;0.30]). Conclusions: Estradiol-based HT may lower atherogenic lipoproteins in post-menopausal women. In primary prevention of coronary heart disease, combining HT and fibrate may provide additional benefits compared to fibrate use.