OBJECTIVES:  The use of simvastatin 40mg is stated as the preferred statin treatment in the 2006 Dutch guideline for cardiovascular risk management. We studied whether this recommendation showed equal or better goal attainment rates in routine daily practice compared to patients treated with other statins. METHODS: Using the PHARMO data network we identified all patients starting statin use in the period 1999 through 2006. Patients suffering from cardiovascular disease or diabetes type 2 were classified as high risk. Treatment goals were defined according to the guidelines of the European Society of Cardiology (2003). Goals for total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were <4.5 and <2.5 mmol/l for high risk patients and <5.0 and <3.0 mmol/l for low risk patients. Patients at goal at baseline were excluded. Goal attainment rates at 12 months were compared between simvastatin 40mg and other statins and doses using logistic regression adjusting for age, gender, year of statin use, CVD, DM2, baseline LDL-C and adherence. RESULTS: We identified 7356 new statin users of which 70% were categorised as being at high risk. Goal attainment rates were similar in the low and in high risk patient groups. Fifty-eight percent of patients treated with simvastatin 40mg attained goal. Both atorvastatin 20 and 40mg (RR 1.16 and 1.22) and rosuvastatin 10 and 20mg (RR1.18 and 1.51) yielded significantly higher goal attainment rates compared to patients treated with simvastatin 40mg . CONCLUSIONS: Results from this study strongly suggest that even after correction of differences in dosing and baseline LDL-C levels, goal attainment with statins in the first year of treatment is significantly more frequent among patients using atorvastatin or rosuvastatin than in patients using simvastatin 40mg. Other studies suggest that these differences translate into reduced cardiovascular risk. This evidence from routine daily practice questions whether recommending simvastatin 40 mg is most beneficial to patients.