OBJECTIVES: European Society of Cardiology and European Atherosclerosis Society dyslipidemia guidelines recommend a low-density lipoprotein cholesterol (LDL-C) target of <70 mg/dL for patients at very high cardiovascular (CV) risk. In clinical trials, statins have proven effective for lowering LDL-C levels in patients with hyperlipidemia, but in routine care, statin use varies and most patients do not attain goal. This study describes LDL-C goal attainment among German patients with atherosclerotic CV disease (ASCVD) who exhibit different patterns in their use of high or moderate intensity statins. METHODS: This retrospective cohort study used electronic medical records data from the IMS^® Disease Analyzer. ASCVD was defined as coronary atherosclerosis, stable/unstable angina, myocardial infarction, ischemic stroke, transient ischemic attack, aneurysm, and peripheral arterial disease. Proportion of ASCVD patients on moderate/high intensity statin with LDL-C <70 mg/dL was determined using the lowest LDL-C value obtained for each patient (index) in each year (2012, 2013, 2014); the LDL-C assessment was required to occur within statin days supply. Treatment patterns were assessed for patients with at least 1-year of post-index follow-up. Results were stratified by year and statin treatment pattern (no change, switch, dose up-/down-titration, discontinuation [≥90 day gap]). RESULTS: In the >14,000 patients assessed in each year (mean age 71 years, 35% female, 8-12% taking high intensity statins), 88-93% were included in treatment pattern analysis. In each year, 79 - 81% of patients remained on the same statin regimen throughout follow-up, 1% switched statins, 14-16% discontinued; 1% of moderate intensity users up-titrated, and 3% of all patients down-titrated. LDL-C goal attainment rates in these treatment pattern groups were 20%, 16-24%, 17%, 11-14%, and 17-19%, respectively. CONCLUSIONS: Majority of the ASCVD patients did not achieve the LDL-C target with moderate or high intensity statins. Despite this lack of LDL-C goal attainment, few patients changed their treatment regimens.