OBJECTIVES: To examine recommended target levels of low-density lipoprotein cholesterol (LDL-C) for hyperlipidaemia patients at high risk (i.e., with two or more risk factors or coronary heart disease or its risk equivalents) for cardiovascular disease (CVD); to determine the proportions of patients who do not achieve targeted LDL-C levels in real-world setting studies. METHODS: A targeted literature review identified guidelines and real-world studies that analysed hyperlipidaemia patients who were not at goal (as defined by study). MEDLINE, Embase, the Cochrane Library, and BIOSIS databases were searched. Guideline publications were searched from 2008; observational studies were searched from January 2005 to December 2013. There were no language or geographical restrictions. RESULTS: CONCLUSIONS: Patients in higher cardiovascular-risk categories tend to have more stringent LDL-C target levels, which may contribute to failure to achieve target levels. This suggests several unmet needs: large numbers of patients who fail to achieve LDL-C targets, reducing the patients’ risk for CVD, and consequently reduce the occurrence of cardiovascular events. Based on recently published American College of Cardiology and American Heart Association guidelines, which do not recommend a treatment target LDL-C level, further research is needed to re-evaluate the unmet need in hyperlipidaemia patients.