OBJECTIVES: To investigate the LDL-c levels and pharmaceutical interventions in Japanese subjects under real life settings based on longitudinal data from a Japanese healthcare checkup database developed by MinaCare Co. Ltd. METHODS: Data of those subjects with annual health checkup from 2010 to 2012 were extracted from MinaCare database (cutoff November 2013). From these data, 11830 subjects with 3 years of parameter values (LDL-c, etc.) were used to assess their longitudinal changes and the self-reported use of medications. The reliability of MinaCare database has been evaluated in a separate investigation to be presented at ISPOR 19^th Annual International Meeting. The final report of this investigation will be based on the latest of the periodically updated database at reporting. RESULTS: At baseline (2010), 11.9% (1410/11830) of the subjects reported LDL-c≥160 mg/dL (target level for low risk hyperlipidemia population). Despite these high LDL-c values, 95.4% (1345/1410) of these subjects answered “untreated by anti-hyperlipidemia drug”  (including one non-respondent). Among these 1345 subjects, 1257(93.5%) answered “untreated” again in 2011; and among these “untreated”, the proportions of subjects with LDL-c<140 (diagnositic level for hyperlipidemia), 160<LDL-c≤180 and LDL-c≥180 in 2011 were 13.5%(n=170), 32.9%(n=413) and 22.9%(n=228), respectively. In contrast, among those who answered “treated” in 2011, the proportion with LDL-c<140 was dramatically higher (69.8%, n=60).Additionally, among those who answered “untreated” in 2011, the proportion answering “untreated” in 2012 (i.e. “untreated” in 3-consecutive years) was 94.1% (n=1183); among these subjects, the proportions of subjects with LDL-c<140, 160<LDL-c≤180 and LDL-c≥180 in 2012 were 16.5%(n=195), 29.8%(n=352) and 25.0%(n=296), respectively. CONCLUSIONS: Our investigation showed that >90% of subjects self-reported no treatment with anti-hyperlipidemia drugs, despite LDL-c levels above 160 mg/dL. Many reported themselves untreated for 3 years. These results revealed a potentially critical gap between healthcare checkup results and subject’s behavior to access medical treatment, suggesting more effective interventions to modify behavior is required.