OBJECTIVES: In support of secondary prevention efforts, NCEP guidelines have affirmed the importance of intensive management of LDL cholesterol in established CHD patients. The objective of this retrospective, cohort analysis was to examine correlates of "optimal" lipid management among newly diagnosed CHD patients. The population was drawn from a health benefits company under capitation (commercial, Medicare) and PPO arrangements. METHODS: Eligible subjects (N=10,125) had an index medical claim for CHD in Year 2000 (ICD-9 CM codes of 410-414, Procedure codes of: 36.0 -36.3), no such diagnostic codes during a previous 24-month "clean" period, no pharmacy claims for a lipid-lowering agent (LLA) in the six month period prior to the index diagnosis, and continuous enrollment during the 36-month observation period. "Optimal" management was defined as at least 1 claim for a LLA in all four quarters of a 12-month post-index follow-up period, coupled with at least 1 lab claim associated with lipid monitoring (lab values were not available for analysis). RESULTS: Patients classified as receiving "optimal" management equaled 4.9%, with 50.3% classified as receiving neither a lab claim nor a LLA. A logistic regression identified five statistically significant (P<0.01) predictors of "optimal" management, including: a) identification by a diagnosis of acute MI; b) age <65 years; c) male gender; d) a comorbidity of hypertension; and e) initial CHD diagnosis by a physician other than a cardiologist/cardiovascular surgeon. CONCLUSIONS: Effective lipid management in patients with CHD has been linked to reduced mortality, decreased morbidity and lower treatment costs. Nonetheless, study findings identify a large gap between the promise of pharmacotherapy and performance in clinical practice. Increased promotion of guidelines emphasizing the importance of aggressive lipid management for both physicians and patients may be necessary to decrease this gap and to achieve desired objectives of secondary prevention of CHD.