OBJECTIVES To assess treatment patterns of lipid-lowering drugs in patients with hyperlipidemia or prior cardiovascular (CV) events (myocardial infarction, unstable angina, revascularization, ischemic stroke, transient ischemic attack or heart failure) who experience new CV events. METHODS A retrospective population-based cohort study was conducted using Swedish electronic medical records and national registers. Patients were included in the study based on a prescription of lipid-lowering treatment between January 1, 2006 and December 31, 2006 or history of CV events (prior to 2006) and followed until December 31, 2012 for identification of new CV events and assessment of treatment patterns. Patients were stratified into three cohorts based on CV risk level. The index was the date of first new CV event during follow-up. All outcomes were assessed during the year following index date. Adherence was defined as medical possession ratio (MPR) >0.80. Persistence was defined as no gaps >60 days in supply of drug used at index date. RESULTS Of patients with CV event history (n=6881), 49% were not on treatment at index. Corresponding data for CV risk equivalent and low/unknown CV risk patients were 37% (n=3226) and 38% (n=2497), respectively. Mean MPR for patients on treatment at index was similar across cohorts (0.74–0.75). The proportions of adherent patients (60–63%) and persistent patients (56–57%) were also similar across cohorts. Dose escalation from the dose at index was seen within all cohorts, most notably for patients with low/unknown CV risk as 25% increased the dose after index. 2–3% of patients switched to a different drug after index while 5–6% of patients augmented treatment by adding another lipid-lowering drug. CONCLUSIONS Almost 50% of secondary prevention patients were not on any hyperlipidemia treatment, indicating a potential therapeutic gap. Medication adherence and persistence among patients on hyperlipidemia treatment were suboptimal.