OBJECTIVES: Statin therapy has established cardiovascular benefits. Clinical guidelines set target cholesterol levels for populations at different risk levels. Treatment strategies include initial high-dose or conventional-dose statin followed by titration of patients failing to reach target. Empirical data on dose titration are scarce, but this model simulates potential cholesterol reductions for different populations, therapies and titration steps. METHODS: Patient-level cholesterol values before statin therapy, obtained from a large UK primary care database, were grouped into four patient groups in 0.5 mmol/L bands from <1-10+: 1) no CVD or diabetes; 2) CVD, no diabetes; 3) diabetes, no CVD; 4) diabetes and CVD. Dose efficacy studies enabled calculation of percentage reductions in cholesterol from specified therapies in each band, variance, and the corresponding probability of reaching a specified target. For patients failing to reach target, the next higher statin dose was applied to the starting cholesterol value. Mean cholesterol values of those above/below target were calculated and inserted into a lifetime, cardiovascular outcomes, Excel-based model using Framingham risk equations and baseline parameters from statin clinical trials. RESULTS: For the 4 population groups, with a mean cholesterol reduction of 30% (SD 10%), proportions reaching a 4mmol/L target in one step were: 1) 24%; 2) 35%; 3) 40%; and 4) 45%. Patients above target had two further titrations, each higher-dose therapy reducing cholesterol by a further 5%, with proportions increasing to 49%, 63%, 68% and 71% respectively. Based on these proportions and using Framingham risk equations, corresponding 10-year CVD event rates were estimated as 27%, 42%, 29% and 55% for one-step therapy, and 23%, 39%, 26% and 52% following titration. CONCLUSIONS: Titration models provide insights about the impact of different therapy strategies on cardiovascular outcomes for different population groups.  The addition of cost data enables the cost-effectiveness of competing statin strategies to be estimated.