OBJECTIVES: Evidence from recent studies on statin treatment intensity for secondary prevention supports targeting lower low-density lipoprotein (LDL) levels through higher intensity statin treatment. This study aims to assess whether achievement of the lower LDL threshold is associated with a reduction in cardiovascular outcomes.   METHODS: Retrospective cohort study of adult members of a large health fund with pre-existing ischemic heart disease (IHD) treated with statins for at least one year during 2006-2010, and with a routine, fasting serum LDL test measures. The incidence of the composite Major Adverse Cardiac Events (MACE) was compared between three patient groups according to their achieved LDL: (>70·1-100mg/dl (Moderate) vs. >100·1-130mg/dl (High), and >70·1-100mg/dl (Moderate) vs. ≤70mg/dl (Low)). RESULTS: Of 52,177 patients treated with statins, 11,647 had an achieved LDL (post-statin treatment) of 70mg/dl or below, 29,097 between 70.1-100mg/dl and 11,433 between 100·1-130mg/dl. Mean follow-up time from achieved LDL to MACE was 3·6 years (±1·5), with 10,955 subjects incurring a MACE during follow-up. LDL levels 70·1-100mg/dl compared to 100-130mg/dl were associated with a significant 8% reduction in the incidence of MACE (hazard ratio [HR]=0·92 [95% CI, 0·88-0·97; p=0·001]), while ≤70 mg/dl compared to 70·1-100mg/dl was not (HR=0·98 [95% CI, 0·93-1·03; p=0·374]). Results remained consistent in propensity score–adjusted Cox regression, a sensitivity analysis, and in a sub-group analysis, with no demonstrated advantage in MACE outcomes for achieved LDL levels ≤70mg/dl.  CONCLUSIONS: Among a real-world population of IHD patients adherent to their statin treatment, achieving LDL levels below 100mg/dl is associated with significant clinical benefit, whereas no additional benefit is gained by achieving LDL levels below 70mg/dl.