OBJECTIVES: Assess statin dosing patterns and lipid levels among United Kingdom high-risk vascular disease (HRVD) patients. METHODS: Patients with HRVD, including acute coronary syndrome (ACS), cerebrovascular arterial disease, peripheral arterial disease, and diabetes with coronary artery disease (CAD), 4/1/2008–3/31/2011, were identified from the Clinical Practice Research Datalink with Hospital Episode Statistics data. Statin doses were assessed from the first prescription on/after the index date (date of diagnosis of cerebrovascular, peripheral, or CAD or 30 days after ACS hospital discharge). Use of high-intensity statin therapy (atorvastatin 40–80 mg or rosuvastatin 20–40 mg) was examined. Across 2 years of follow-up, upward-dose titration was noted. Lipid levels were examined for high-intensity and non-high-intensity statin users and non-users. RESULTS: Of 63,549 statin users with HRVD and ≥6 months’ follow-up, most (69.6%) received simvastatin; also prescribed were atorvastatin (23.3%), pravastatin (3.6%), rosuvastatin (3.2%), and fluvastatin (0.4%). The most frequent initial drug-dose combinations were simvastatin 40 mg (48.5%) and 20 mg (15.5%) and atorvastatin 40 mg (8.2%) and 80 mg (5.4%). Upward-dose titrations occurred in 8.9% of patients in 2 years. High-intensity statin use across 2 years was 16.4% overall and highest in ACS (28.9%) relative to other HRVD conditions (range 8.8%–20.9%). Among patients with ≥1 low-density lipoprotein cholesterol (LDL-C) record in 2 years, 41.3%, 35.5%, and 5.3% of patients on high-intensity, non-high-intensity, and no statin had LDL-C <1.8 mmol/L. Similar patterns were seen with total cholesterol, but high-density lipoprotein cholesterol (HDL-C) >1.2 mmol/L was observed in 46.3%, 54.9%, and 66.1% of high-intensity users, non-high-intensity users, and non-users, respectively. CONCLUSIONS: Simvastatin 20–40 mg or atorvastatin 40–80 mg were most frequently prescribed for HRVD patients. Upward-dose titration was seldom seen. Statin use, especially at high intensity, was associated with lower LDL-C, although statin use was not associated with higher HDL-C.