OBJECTIVES: Current guidelines for cholesterol treatment recommend statin therapy for patients with clinical atherosclerotic cardiovascular disease (ASCVD) and heterozygous familial hypercholesterolemia (HeFH). The goal of this study was to evaluate low density lipoprotein-cholesterol (LDL-C) levels and rates of statin and ezetimibe utilization among these patients. METHODS: Patients ≥18 years newly initiating statin therapy (‘index’) were identified from 2012-2014 using the MarketScan® Databases. Evidence of clinical ASCVD (using ACC/AHA definition with ICD-9 diagnosis codes) and/or probable HeFH (based on LDL-C cutoffs defined by the National Lipid Association) was required in the 12 months pre-index.  Patients were followed for 365 days after the index date to identify LDL-C achievement and ezetimibe augmentation. RESULTS: CONCLUSIONS: Among patients in our study with clinical ASCVD and/or HeFH, 37% did not achieve the recommended LDL-C below 70 mg/dL while on statin therapy.  Augmentation or switching to ezetimibe was rare among patients with clinical ASCVD or HeFH.  Given the high proportion of patients with LDL-C levels >70 mg/dL more aggressive treatment options are warranted.