Atherosclerotic disease represents an enormous burden in the elderly population, yet elderly patients are underrepresented in clinical trials and receive lower standard-of-care treatment compared with similar-risk younger individuals. Magnetic resonance imaging (MRI) is a powerful noninvasive imaging technique that can target atherosclerotic lesions and help better understand the pathophysiologic process of this disease in the elderly. Cholesterol-targeted interventions have improved the outcomes in patients with atherosclerotic disease, but clearly additional efforts are needed. Whether medical therapy can be effectively adjusted based on atherosclerosis progression revealed by MRI is still to be proven, but the technique certainly looks promising.