OBJECTIVES: The aim of this study was to assess the prevalence and characteristics of subjects with a recent ACS episode (in the year preceding statin prescription) appropriately treated with high-efficacy statins, and who have inadequate control of LDL-C levels, despite being adherent to treatment  METHODS: An observational retrospective cohort analysis based on five Local Health Units administrative databases was conducted, for a total number of 1.2 Million beneficiaries. Patients who have been hospitalized with ICD9 code 410 in the year preceding their first statin prescription (between January 1, 2011 and December 31, 2012) were included. Patients were characterized back 12 months from index date to assess appropriateness and adherence to statin treatment RESULTS: Among patients with recent ACS enrolled (1’098 patients), 549 (50%) had no LDL-C determination, 335 (31%) and 214 (19%) displayed LDL-C under control and out of control, respectively. Among patients with uncontrolled LDL-C, 16 (7%) and 198 (93%) were not treated and treated with statins, respectively. Among patients with statins treatment, 27 (14%) and 171 (86%) were treated with low and high efficacy statins, respectively. Finally, among patients treated with high efficacy statins, 115 (67%) and 56 (33%) were non-adherent and adherent to high efficacy statin treatment, respectively. LDL-C uncontrolled high efficacy adherent patients showed different distances from their lipid target: 33.9% were less than 10% distant, 16.1% were 10-19% distant, 14.3% were 20-29% distant, 12.5% were 30-39% distant and 23.2% were more than 40% distant CONCLUSIONS: These results are topical, as new monoclonal antibodies are being marketed to address the unmet need in cholesterol statin-management of dyslipidaemia for uncontrolled patients. By projecting study percentages to the Italian population, the number of LDL-C measured patients with a recent ACS episode who are uncontrolled, despite being adherent to a high efficacy statin, would be around 6’524