OBJECTIVES: This study longitudinally examined the prevalence of lipid abnormalities and utilization of lipid-modifying therapies (LMT) to determine treatment gap in Mexican patients from regular clinical practice. METHODS: Using standardized chart from The Instituto Nacional de Ciencias Medicas y Nutricion, we identified patients ≥18 years of age, who initiated LMT between July 2001 and September 2007, continued treatment for 1 year, and had a complete lipid panel (LDL-C, HDL-C and triglycerides) one-year pre and post therapy. Patients with history of coronary heart disease (CHD), diabetes and 10-year CHD risk>20% were classified as high CV risk. Threshold levels for LDL-C, HDL-C and triglycerides were specified as per NCEP ATPIII Guidelines. RESULTS: Among 332 patients, at baseline, 2% had complete lipid control while 74%, 44% and 82% experienced elevated LDL-C, low HDL-C and elevated triglycerides respectively. Elevated LDL-C coupled with low HDL-C and/or elevated triglycerides was prevalent among 61%. LMT was introduced after one year with about 30% patients utilizing statin monotherapy and statins in combination with fibrates while about one-third used fibrate monotherapy. Post therapy, 71%, 47% and 77% continued to experience elevated LDL-C, low HDL-C and elevated triglycerides respectively while elevated LDL-C coupled with low HDL-C and/or elevated triglycerides persisted among 58%.  A subset of high risk patients (n=104) had similar results with no meaningful improvement in lipid abnormalities pre and post therapy. CONCLUSIONS: In this longitudinal study of Mexican patients, there were no meaningful improvements in proportion of patients with controlled LDL, HDL-C, TG or multiple lipid abnormalities after initiation of LMT. Prevalence of lipid abnormality pre and post treatment did not change notably despite relatively high proportion of patients (over 60%) using fibrate therapy, either alone or in combination with statins. Economic and social issues are most likely contributing to poor goal attainment rates.