OBJECTIVES: Examine lipid-altering drug use patterns, statin adherence, and persistence among patients with high-risk vascular disease (HRVD) in the United Kingdom (UK). METHODS: Patients with HRVD, including a history of acute coronary syndrome (ACS; >30 days–365 days after discharge for ACS), cerebrovascular arterial disease, peripheral arterial disease, or diabetes with coronary artery disease, 4/1/200–3/31/2011, with a minimum of 12-month continuous enrollment before the index date were identified using the Clinical Practice Research Datalink with Hospital Episode Statistics data. The date of the first HRVD diagnosis satisfying the above inclusion criteria was defined as the index date. Use of lipid-altering drugs was measured during the 6-, 12-, and 24-month follow-up periods. Statin adherence (medication possession ratio [MPR]), was obtained for 6, 12, and 24 months after the index date. Statin persistence was estimated as the time from earliest statin use on or after the index date until the last date of exposure prior to a gap of ≥30 days. RESULTS: Of 119,267 HRVD patients with ≥6-month follow-up, 59.8% of patients used statin monotherapy, 3.3% used statin combination therapy (i.e., statin plus ezetimibe, niacin, fibrates, or bile acid sequestrants), and 35.3% had no recorded lipid-altering therapy. The usage patterns of statins and other lipid-altering drugs changed little during the rest of the 24-month follow-up period. The mean/median MPR during the 6-, 12-, and 24-month follow-up periods was 0.88/0.97, 0.85/0.96, and 0.82/0.94, respectively, among HRVD patients who used a statin with 76.9%, 74.8%, and 71.3% of patients adherent (MPR≥80%) to their statin therapy. Median time to discontinuation of the index statin was 523 days during the 24-month follow-up period. CONCLUSIONS: Close to two-thirds of HRVD patients used statin or other lipid-altering drugs during the 24-month follow-up period. Statin adherence and persistence were high among patients with HRVD in the UK.