OBJECTIVES: Objective: Despite the efficacy and safety of statins, real-world data suggest they are suboptimally used among dyslipidemic patients. The current study sought to describe patterns of statin utilization among high cardiovascular (CV)-risk patients initiating statin therapy. METHODS: Methods: Adult patients (≥18 years) with continuous enrollment who were newly initiating statins were identified from the Truven MarketScan Research databases (01/2007-06/2013). Patients were selected for and stratified into 1 of 5 mutually exclusive, high CV-risk–based hierarchical categories: recent acute CV event ( hospitalization for acute coronary syndrome [ACS] or other CV event within 90 days of index), coronary heart disease (CHD), ischemic stroke, peripheral vascular disease/peripheral artery disease (PVD/PAD), and diabetes. Descriptive statistics and time-to-event analyses were used to measure proportion of days covered (PDC), time to discontinuation, and hospitalization rates. RESULTS: Results: Among 541,221 high CV-risk patients, 61% were in the diabetes cohort, followed by recent acute CV event (26%), PVD/PAD (5%), CHD (4%), and ischemic stroke (4%). High-intensity statins (atorvastatin 40/80 mg, rosuvastatin 20/40 mg, simvastatin 80 mg) were initiated in 15% of patients, with the percentages varying among subgroups (10% [diabetes] to 31% [ACS]). More than 20% of high-intensity statin initiators switched to a moderate- to low-intensity statin (range, 19% [PVD/PAD] to 28% [other CV event]). The PDC ranged from 56% (diabetes) to 66% (ACS). Median time to statin discontinuation among high CV-risk patients was approximately 15 months. Median time to discontinuation among patients receiving high-intensity versus moderate- to low-intensity statin was 21 months and 15 months, respectively. At 1 year, Kaplan-Meier estimates of cumulative event rates for CV-related hospitalizations were lowest in the diabetes cohort and highest for patients with recent ACS hospitalization (4% and 22%, respectively). CONCLUSIONS: Conclusion: Low PDC and discontinuation of statin therapy were observed among high CV-risk patients. Interventional opportunities to ensure better therapy management are warranted.