OBJECTIVES: NCEP ATP III guidelines expanded indications for intensive cholesterol-lowering therapy by focusing on primary prevention in individuals with multiple risk factors. This study examined the impact of guidelines on pharmacologic treatment patterns in individuals at high risk for cardiovascular disease. A retrospective database study was conducted in a large multi-site managed care organization. Specific objectives were to: 1) determine prevalence of high-risk members; 2) assess existing LDL testing patterns; 3) assess patterns of medication treatment: 4) assess the impact of ATP III guidelines on lipid outcome; and 5) examine medication possession ratios - Days supply of statin / (End date of study - First prescription date) for goal achievers versus non-achievers. METHODS: Medical, laboratory and pharmacy records of members aged 18 years and over and continuously enrolled for 30 months were reviewed to identify individuals with a diagnosis of coronary artery disease (CAD) or risk equivalent (one or more of the following: peripheral artery disease, abdominal aortic aneurysm, symptomatic carotid artery disease, diabetes). RESULTS: Of 422,914 members who met age and enrollment criteria, 16,036 (3.8%) were high risk. 38.4% of high-risk members had LDL tests during the observation period. 38.1% of high-risk members received a prescription for a cholesterol-lowering drug. 34.7% of high-risk members reached NCEP ATP Goal <100mg/dl LDL. Members with anti-lipidemic prescriptions were significantly more likely to reach ATP III goal (42.2% vs. 26.6%) (measured by Test of Proportion Z=12.78). A Wilcoxon Rank Sum test indicated that Risk and Risk EQ Ss who reached goal were significantly more likely to have a high Possession Ratio than those who did not reach goal. CONCLUSIONS: Managed care provides numerous opportunities to improve cardiovascular health through identification of high risk members, educating physicians on NCEP ATP III guidelines; more aggressive testing and treatment, patient compliance counseling and monitoring of goal performance.