To evaluate the validity of self-reported lipid medication use in an epidemiological study.We studied medication self-reports compared with inventoried lipid medication containers at the fifth visit of the Atherosclerosis Risk in Communities (ARIC) Study in 2011–2013 (n = 6370). To assess the validity of self-reports, we computed sensitivity, specificity, positive and negative predictive values. We used multiple logistic regression to determine whether validity varied by participant characteristics. Comparisons were made with visit 4 (n = 11,531), to determine if there was a change in validity as the pattern and types of lipid medication used changed over time.The prevalence of lipid medication use, according to medication containers was higher at visit 5 (56%) than visit 4 (14.3%). Statins were increasingly used. The percentage of participants reporting use/non-use accurately was 91.8% at visit 5, lower than visit 4 (97.3%). The unadjusted kappa coefficient of agreement was 0.83 (95% CI – 0.82 to 0.85) at visit 5 and 0.89 (95% CI – 0.88 to 0.90) at visit 4. Agreement was higher, compared with their counterparts, for women, younger and more educated participants, and those using fewer total medications.In this population sample, self-reported lipid medication use was highly accurate and therefore likely would be for similar epidemiological studies or clinical settings collecting this information.