OBJECTIVES: To estimate real-world utilisation of lipid modifying therapy (LMT) and low-density lipoprotein cholesterol (LDL-C) goal attainment in the United Kingdom. METHODS: Individuals with their first and, if present, repeated cardiovascular (CV) related hospitalisations were identified from 2006-2012 Clinical Practice Research Datalink and Hospital Episode Statistics data. Patients >18 years receiving LMT within 180 days before the CV (index) event were followed for 12 months. Patient cohorts were classified as CV Low/Moderate Risk, CV High Risk, and CV Event History.  Adherence (medication possession ratio), persistence, switching, and therapy augmentation were calculated for statins, ezetimibe and fibrates during the follow-up period.  Attainment of the recommended LDL-C target of <1.8 mmol/L was assessed for risk groups at the index and 12 months afterward. RESULTS: Across cohorts, 97% were receiving statins before or at index. Moderate intensity statins were used the most. Medication possession ratio ranged from 0.76-0.79 for statins, 0.72-0.79 for ezetimibe, and 0.58-0.73 for fibrate users.  Persistence at 12 months was 51%-52% for statin, 40%-50% for ezetimibe, and 36%-45% for fibrate users.  Approximately 2% of statin users switched to new medications, compared to 11%-16% of ezetimibe users, and 11%-19% of fibrate users.  Nearly 4% of statin users augmented their regimen during the year, compared with 56%-61% of ezetimibe and 38%-51% of fibrate users.  The proportion of patients not meeting the LDL-C target was 71% and 69% in the CV High Risk and CV Event History cohorts at index, respectively, and 65% for both at 12 months.  Approximately 60% of diabetic patients of CV High Risk cohort did not meet LDL-C target at both index and 12 months. CONCLUSIONS: Adherence to LMT after CV events was best for statins.  Patients receiving fibrates or ezetimibe had higher rates of switching or augmentation. LDL-C goal attainment is low, representing a substantial unmet medical need.