OBJECTIVES: To estimate the prevalence of statin therapy in high-risk patients new to Acute Coronary Syndrome (ACS) events, and establish the extent to which these lipid abnormalities were addressed by one-year statin therapy in Hong Kong clinical practice. METHODS: The study was a retrospective analysis, conducted using the electronic database from a Hong Kong tertiary referral hospital. Patients (n=186) who were hospitalized for ACS events during Sep 2009-Mar 2010 were identified. Two periods were studied as follows: a pretreatment period, defined as the 6 months before the index hospitalization, and an average follow-up period of 12 months after the index hospitalization. RESULTS: Before the index day, 67 (36.0%) of patients had started statin monotherapy. At the index day, 84.9% had ACS events with at least one abnormal lipid measurement (total cholesterol (TC)≥200mg/dl(5.2mmol/L), low-density lipoprotein cholesterol (LDL-C)≥100mg/dL(2.6mmol/l), high-density lipoprotein cholesterol (HDL-C)≤40mg/dL(1.0mmol/L), or triglycerides (TG)≥150mg/dL(1.7mmol/L)). Within one week after ACS events, 58.8% of those (n=119) who had not used statin before, initiated on statin therapy. Moderate- and low-potency were by far the most commonly initiated dosing scheme and simvastatin was the most-prescribed drug. After one year’s treatment, the percentage of patients who had no lipid abnormalities increased from 15.1% to 40.1%. The prevalence of high TG levels decreased from from 41.4% to 33.8%, while that of low HDL-C levels was reduced, from 40.9% to 29.0%. The proportion of patients with abnormal LDL-C levels decreased from 58.6% to 21.9% over 12 months but only twenty percent achieved the goal of a 50% reduction recommended in 2013 ACC/AHA guideline. Lipid goal attainments were highly correlated with baseline lipid levels. CONCLUSIONS: Despite poor LDL-C goal attainments, many high-risk individuals after major cardiovascular events have no statin add-on therapy. Management of ACS is therefore suboptimal in HK general practice.