BACKGROUND: Despite effective lowering of low density lipoprotein cholesterol (LDL-C) with statin for prevention of cardiovascular events, risk remains high in those with mixed dyslipidemia. OBJECTIVES: To examine the prevalence of dyslipidemia before and after lipid modifying therapy (LMT) use in Thailand. METHODS: We recruited 807 patients (mean age 59 and 45.2% male) who, between January 2001 and June 2007, aged ≥35 years, initiated LMT, had ≥ 1 lipid abnormality and follow-up >12 months after initiating LMT, with a complete lipid panel (LDL-C, high density lipoprotein cholesterol [HDL-C] and triglycerides[TG]) before and 12 months after therapy. Patients with coronary heart disease (CHD), type 2 diabetes or a 10 year CHD risk>20% were classified as high (cardiovascular) risk patients. Threshold levels for LDL-C, HDL-C and triglycerides were specified as per NCEP ATPIII Guidelines. RESULTS: At baseline, 65%, 34% and 43% exhibited elevated LDL-C, elevated TG, and low HDL-C, respectively while 35% had elevated LDL-C alongside low HDL-C and/or elevated TG. Among high-risk patients (n=430), 68%, 35% and 44% exhibited elevated LDL-C, elevated TG and low HDL-C, respectively; while 38% had elevated LDL-C alongside low HDL-C and/or elevated TG. Among the sample, 77% were on statins, 7% on fibrates, and 13% on both. After 12 months, 21%, 32% and 39% of patients still had elevated LDL-C, elevated TG and low HDL-C, while 18% had elevated LDL-C alongside low HDL-C and/or elevated TG.  High-risk patients had similar degrees of persistent dyslipidemia with 27%, 25%, 44% and 21% experiencing elevated LDL-C, elevated TG, low HDL-C, and elevated LDL-C alongside low HDL-C and/or elevated TG, respectively. CONCLUSIONS: This cohort had improved LDL-C levels after therapy, with no improvement of TG and HDL-C levels among the overall, and moderate and negligible among the high-risk population, respectively.  These patients may benefit from other types of LMT.