OBJECTIVES: International guidelines recommend the use of high dosages statins (in particular, Rosuvastatin and Atorvastatin) in high cardiovascular (CV) risk patients. The aim of this study was to assess the degree of implementation of the recommended therapeutic strategies and clinical outcomes as a function of the therapeutic strategies in a real world setting. METHODS: An observational retrospective cohort analysis based on 4 Local Health Units administrative databases was conducted. High CV risk patients who filled at least one prescription for high dosages statins between 01/01/2007-31/12/2007 (enrolment period) were included. Patients were followed-up for 24 months. Patients were defined as adherent if they had >80% of follow up period covered by drugs dispensation. To correct for potential confounders, a multivariable proportional hazards Cox regression model considering age, gender, type of statin, adherence to treatment and stay on treatment was assessed. Stay on treatment was defined as no switch or down titration during the follow up period. RESULTS: Among 36,327 (3% of the population) high CV risk patients, Rosuvastatin 40mg (R40) and Atorvastatin 80mg (A80) were not used (0.1% each treatment); 625 (2%) patients used R20 and 908 (2%) A40. Stay on treatment was similar across treatments: 61% for R20 and 60% for A40 (p=0.583). 2.6 (1.7-3.5) CV events per 100 patients/year for R20 and 4.4 (3.4-5.4) for A40 were observed (p=0.014). At the multivariable Cox regression analysis, risk of CV event was lower for R20, as compared to A40 (HR=0.60, 95%CI 0.39-0.91, p=0.017). Other statistically significant covariates were adherence (HR=0.50, 95%CI 0.29-0.87, p=0.015) and stay on treatment (HR=0.58, 95%CI 0.40-0.85, p=0.006). CONCLUSIONS: Despite guidelines recommendations, high dosages statins are poorly used in real practice. Stay on treatment was similar among those treated with R20 and A40, even though R20 showed a lower incidence of cardiovascular events.