OBJECTIVES: To compare lipid management and reductions in total cholesterol (TC) levels among patients initiated on lipid lowering drugs (LLD) in recent years (2002-2004) to those initiated in earlier years (1991-2001). METHODS: Data were obtained from a sample of the PHARMO system that includes complete medication, hospital admission and clinical lab assessment data of 80,000 Dutch residents. Patients starting LLD therapy and having a baseline TC measurement within six months prior to therapy initiation as well as at least one measurement after the start of therapy were included in two study cohorts. One cohort included patients who initiated therapy in 2002-2004 and another that initiated therapy in 1991-2001. Goal attainment was defined as TC < 5 mmol/l during LLD treatment according to Dutch guidelines. Statin dosage was expressed in equipotencies based on TC lowering capabilities. RESULTS: Patients with cholesterol levels < 6 mmol/l were more likely to be treated in the period 2002-2004 than in the period 1991-2001 (27% versus 15% of all patients, respectively). Furthermore, equipotent dose at the start of statin monotherapy gradually increased over the years; in 1996 13.7% of the patients started with at least an equipotent dose of four (simvastatin 20 mg or equipotent) while in 2004 88.4% of all patients started on at least an equipotent dose of four. Goal attainment increased from 42% in years prior to 2001 to 59% in 2002-2004 and was high in patients with cardiovascular disease and diabetes (43% versus 69%). CONCLUSION: Although in recent years aggressive statin treatment and lower baseline TC levels led to higher goal attainment 41% of the patients still did not reach goal. Therefore even more effective and well tolerated lipid lowering therapies seem to be required.