OBJECTIVES Individuals who are not at ATP III (Adult Treatment Panel III) LDL-C goal are recommended to take statins along with lifestyle modifications. Different lipid lowering therapies (LLT) vary in their average LDL-C efficacy. The goal of this retrospective, observational study is to examine the association between initiation of selected statins and LDL-C levels before the prescribing in a cohort of CHD/CHD risk equivalent individuals. METHODS Using a large managed care administrative claims database, we identified individuals with at least one prescription for simvastatin plus ezetimibe fixed dose combination (simvastatin/ezetimibe), simvastatin, atorvastatin, or rosuvastatin between January 01, 2005 and December 31, 2006. Patients were excluded if they met any of the following criteria: use of any LLT during the 6 months prior (baseline) to the index (first prescription) date; prescription fills for more than one LLT on the index date; no lab value; or at LDL-C goal (<100 mg/dL) at baseline based on ATP III cholesterol guidelines. Three logistic regression models adjusting for age and gender were developed to examine the association between being ≥50% away from LDL-C goal at baseline and simvastatin/ezetimibe initiation (N=2246) relative to simvastatin (N=2615), atorvastatin (N=5703), and rosuvastatin (N=1446) monotherapy. RESULTS A total of 13,651 eligible patients were treatment naïve and not at LDL-C goal at baseline. Compared to individuals who were <50% away from the ATP III goal, patients who were 50% or more away from goal were 1.8 (95% CI = 1.6 – 2.1), 1.4 (1.2 – 1.5), and 1.1 (0.9 – 1.2) times more likely to be prescribed simvastatin/ezetimibe rather than simvastatin, atorvastatin, and rosuvastatin monotherapy, respectively. CONCLUSIONS The positive association between being ≥50% away from LDL-C goal and initiation of simvastatin/ezetimibe vs. simvastatin or atorvastatin suggests that physicians were choosing simvastatin/ezetimibe because of the anticipated higher efficacy with this combination than the statin monotherapy studied.