OBJECTIVES: Despite the known benefit of low-density lipoprotein cholesterol (LDL-C) goal attainment of less than 70 mg/dL in a reduced risk of cardiovascular events, its effectiveness in acute coronary syndrome patients in Thailand is limited. This study aimed to assess the effect of LDL-C goal attainment on first composite cardiovascular outcomes. METHODS: A retrospective cohort study was conducted using medical charts of patients who were hospitalized for acute coronary syndrome and were treated with statins at a tertiary care hospital in Thailand between 2009 and 2012. After admission, patients were followed from the date of LDL-C goal assessment until the first event of composite cardiovascular outcomes (myocardial infarction, stroke, death). Median follow-up time was 544 days (interquartile range: 224-887 days). Cox proportional hazard models were used to determine the effect of LDL-C goal attainment on the cardiovascular outcomes.  RESULTS: A total of 405 patients were included. Mean age was 65 years (60% males). Twenty-seven percent of the patients attained a LDL-C goal of <70 mg/dL, 38% had LDL-C between 70 and 99 mg/dL and 35 % had LDL-C ≥ 100 mg/dL.   Forty-six patients experienced a composite cardiovascular outcome.  Patients achieving a LDL-C of <70 mg/dL was associated with a lower composite cardiovascular outcome compared to patients with a LDL-C ≥ 100 mg/dL (adjusted HR=0.41; 95% CI= 0.18 – 0.93; p-value=0.034). Patients with a LDL-C between 70-99 mg/dL had a lower composite cardiovascular outcome compared to patients with a LDL-C ≥ 100 mg/dL but was not statistically significant (adjusted HR= 0.72; 95%CI= 0.37 – 1.42; p-value=0.346). CONCLUSIONS: Acute coronary syndrome patients who received statins and achieved a LDL-C of < 70 mg/dL were more likely to have less cardiovascular outcomes, confirming the data from clinical trials that “the lower LDL-C the better”. Improvements in goal attainment for LDL-C are encouraging.