OBJECTIVES: Statins are the first recommended pharmacotherapy to lower LDL-C, with rosuvastatin as the most potent available statin. Clinical outcomes are improved with statin use in patients at high risk for cardiovascular disease (CVD). Guidelines recommend specific LDL-C goals for patients dependent on pre-existing CV risk factors. The present analysis examined LDL-C goal attainment in US patients at high CV risk treated with rosuvastatin monotherapy. METHODS: In a retrospective study using the GE Healthcare Centricity database, patients who received a prescription (Rx) for rosuvastatin monotherapy (index Rx) between January 1, 2008 and December 31, 2010 were identified. Included were patients with coronary heart or atherosclerotic vascular disease, ≥1 LDL-C measurement between 3 months and 1 year post-index Rx, and medical records for 1 year prior to and following index Rx. Proportions of patients attaining LDL-C <70 and <100 mg/dL were estimated for all patients, as well as by rosuvastatin daily dose. RESULTS: Of 6004 patients (age=66 yrs [SD 10]; 56% males), 15%, 39%, 29%, and 17% received Rxs for 5, 10, 20 and 40 mg rosuvastatin, respectively. Overall, mean follow-up LDL-C was 89 mg/dL (SD 37); only 32% of patients had an LDL-C <70 mg/dL and 72% had an LDL-C <100 mg/dL. By increasing dose, mean LDL-C decreased and proportions at goal generally increased. For goal of LDL-C <70 mg/dL, 39% of all patients had a follow-up LDL-C ≥20 mg/dL above this goal, while 16% had an LDL-C ≥20 mg/dL above the 100 mg/dL goal. CONCLUSIONS: The proportion of patients at high CV risk achieving recommended LDL-C goals with rosuvastatin monotherapy was suboptimal, with more than 63% not achieving the current optional LDL-C goal of <70 mg/dL across doses. This suggests a treatment gap and more effective lipid-lowering strategies, such as aggressive dose titration or additional therapies, are warranted in this high-risk population.