Objective To study the relationship between serum lipid level and colorectal adenoma in elderly pations. Methods The clinical data for 265 pations aged 60 and over of cadre wards from August 2010-August 2013 in this hospital underwent colonoscopy were retrospectively analyzed. They were divided into two groups: patients with colorectal adenoma and those without colorectal adenoma. The serum total cholesterol, triglyceride, HDL cholesterol and LDL cholesterol levels in the two groups were analyzed. Results The levels of total cholesterol, triglyceride in serum of patients with colorectal adenoma were much higher than those in the control group (P<0.05), the levels of HDL cholesterol were much lower (P<0.01). HDL cholesterol adenoma group decreased significantly than that in control group (P<0.05). Conclusions The findings of this study suggest that dyslipidemia may affect the incidence of colorectal adenoma.Total cholesterol, triglyceride in serum can promote occurrence and deterioration of colorectal adenomatous, but HDL cholesterol in serum has inhibiting effect.