BACKGROUND: To study the use and effectiveness of lipid-lowering drugs with respect to lowering of cholesterol levels in routine daily practice. METHODS: 20 392 patients for whom lipid levels records were available between January 1991 and December2001 were included in this retrospective population based cohort study. From this group of patients 1899 patients started treatment during the study period and had at least one baseline cholesterol measurement during the six months prior to the initiation of lipid lowering drugs and at least one cholesterol measurement after initiation. A patient was defined to be ‘at goal’ if the patient had a total cholesterol less than 5.0 mmol/L. RESULTS: Our results indicate that only 30.2% of all treated patientsachieved goal in the first year of treatment. After the introduction of new guidelines in 1998, recommending more aggressive treatment, the goal attainment percentage rose from 22.4% of those patients treated before 1998 to 42.3% for those in whom treatment was initiated after 1998. CONCLUSION: The percentage of patients achieving guideline recommended goal is low in real-life even in patients treated with high dose statins.