OBJECTIVES:  To estimate the number and cost of cardiovascular (CV) events avoided over five years by treating with statins to alternative low-density lipoprotein cholesterol (LDL-C) targets of <3.0mmol/L and <2.0mmol/L, based on 1,000 patients with established cardiovascular disease (CVD) or diabetes from an NHS perspective. METHODS: Proportional effects per mmol/L LDL-C reduction for non-fatal myocardial infarction (MI), coronary revascularisation and stroke were taken from a meta-analysis of 14 randomised controlled trials of statin therapy.  Absolute risk reductions (ARR) between control and treatment arms were calculated.  Baseline LDL-C value of 3.6mmol/L (SD 1.27) was taken from the Health Survey for England 2003 and 5000 LDL-C values ≥3.0mmol/L and ≥2.0mmol/L were randomly generated from this distribution giving mean baseline LDL-C values of 4.24mmol/L and 3.86mmol/L respectively.  Absolute LDL-C reductions needed to meet the alternative targets were calculated and ARR in CV event incidence applied.  The % reduction in CV events for 1000 patients was used to estimate number of CV events avoided; costs of events avoided were calculated using the National Tariff 2007-08. RESULTS: ARR between control and treatment arms was 1.8%, 1.8% and 0.6% for MI, coronary revascularisation and stroke respectively.  Absolute reduction required to meet the LDL-C target of <3.0mmol/L was 1.24mmol/L resulting in 51 CV events avoided (22 MIs; 22 CABG/PTCAs; 7 strokes), with a total cost saving of £220,714 (MI = £70,158; CABG/PTCA = £130,368; stroke = £20,188).  The 1.86mmol/L required to meet the LDL-C target <2.0mmol/L resulted in the 77 CV events avoided (33 MIs; 33 CABG/PTCAs; 11 strokes) with a total cost saving of £332,512 (MI = £105,237; CABG/PTCA = £195,551; stroke = £31,724). CONCLUSIONS: The estimated benefit of treating to an LDL-C target of <2.0mmol/L rather than <3.0mmol/L was an additional 26 CV events avoided per 1,000 patients with an associated cost saving of £111,799.