OBJECTIVES: Evidence-based guidelines for dyslipidemia therapy have provided definitive goals for low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) and suggested abnormal values for high-density lipoprotein cholesterol (HDL-C).  The study objective was to determine lipid value attainment and dyslipidemia treatment rates. METHODS: Adult patients with two or more complete lipid panels from January 2005 through February 2009, regardless of dyslipidemia therapy, were identified from the US nationally-representative HealthCore Integrated Research Database™ (HIRD).  Cardiovascular risk status was assigned based on National Cholesterol Education Program (NCEP) criteria.  Optimal lipid value (target) attainment was defined using NCEP, American Heart Association, and American Diabetes Association criteria.  Target attainment for LDL-C, HDL-C and TG and lipid therapy treatment patterns are described. RESULTS: A total of 227,903 patients were identified (mean follow-up =1.9 years).  At index lab, 21.1% of patients were at target for all three lipid fractions, 11.9% had no lipid fractions at target, 66.3% were at LDL-C target and 63.6% were not at target for either HDL-C or TG.  Regardless of initial lipid fractions, only 28.7% of patients attained target over follow-up in all three lipid fractions.  In patients with no lipid fractions at target at index, only 6.8% attained target for all lipid fractions and almost a third (31.9%) stayed at no lipid fractions at target; 44.4% of patients were receiving lipid-modifying therapy as of the last lipid lab (up from 33.0% at index), with twice as many on therapy attaining all targets versus no targets (66.6% vs. 29.0%).  Statins were the most commonly used therapy (35.8%). CONCLUSIONS: Challenges to mixed dyslipidemia therapy still exist as evidenced by a minority of patients attaining optimal lipid values during the very recent timeframe of this study.  These data may serve as valuable baseline benchmarks to evaluate the impact of new dyslipidemia guidelines and therapies.