OBJECTIVES: The Adult Treatment Panel III guidelines suggest that the goal of low-density lipoprotein cholesterol (LDL-C) in patients with both cardiovascular disease and diabetes is <100mg/dL. Many patients remain poorly controlled despite various interventions in primary care, including statin therapy and health behavior modification. We evaluated the impact of adding a clinical pharmacist intervention to usual care on LDL-C control and treatment costs in diabetic cardiac patients. METHODS: We prospectively compared a clinical pharmacist intervention in 138 patients with a matched control sample of 353 patients receiving usual care in Maccabi Healthcare Services (MHS) in Israel. Patients with cardiovascular disease and diabetes and LDL-C levels >100mg/dL were identified from the MHS's computerized database. The clinical pharmacist reviewed patients' clinical charts and discussed the recommendations to improve hyper-lipidemic control with the patients' primary-care practitioners. The recommendations were given every three months for a one-year period. The primary clinical endpoint was reaching LDL-C goal. Clinical outcomes and overall treatment costs in both groups were evaluated at the end of the study year. RESULTS: During the study year, 67% of the patients in the intervention group reached the LDL goal vs. only 54% in the control group (p=0.014).  LDL target was reached three months earlier in the intervention group as compared with control patients (0.710 year vs. 0.992 year, respectively; log-rank test: p=0.015). However, at the end of the study year, LDL target was maintained in approximately 50% of patients in both groups. Overall treatment costs (physician visits, hospital and emergency room admissions, lab tests, medications) were 14% lower in the intervention group and 11% higher in the control group as compared to the year prior the intervention. CONCLUSIONS: A clinical pharmacist intervention in high-risk patients may result in clinical improvements and lower treatment costs. These results demonstrate the high-value of clinical pharmacist involvement in patient treatment.