OBJECTIVES: To evaluate current lipid management practice in Netherlands and estimate the impact of new guidelines of the European Society of Cardiology (ESC) on cholesterol goal attainment. 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 lipid lowering drug (LLD) therapy between 2002-2004 who had a baseline TC measurement in the six months prior to initiation of therapy and had at least one TC measurement after the start of therapy were included. Goal attainment was compared using the ESC 1998 and ESC 2003 guidelines. For both guidelines goal attainment was in general defined as TC < 5 mmol/l during LLD treatment. However, in the ESC 2003 guidelines goal attainment was defined as TC < 4.5 mmol/l during LLD treatment for patients with cardiovascular disease or diabetes. Doses of statins were expressed in equipotencies based on TC lowering capabilities. RESULTS: The study sample comprised of 623 patients (43% females). Most patients (83%) were initiated on statin monotherapy of at least an equipotent dose of four (simvastatin 20 mg or equipotent statin). Overall TC goal attainment rate based on 1998 guidelines was 59% and based on new ESC guidelines was 49%. Goal attainment in patients with cardiovascular disease or diabetes changed from 69% to 49% based on old and new guidelines respectively. Our results also indicated that persistent statin use during follow-up increased goal attainment (54% versus 44% in not persistent patients using new ESC guidelines). CONCLUSION: Though lipid management in recent years has become more aggressive, achievement of cholesterol goals based on the new ESC guidelines is relatively low. Therefore there is a need for highly effective lipid lowering therapies that are also well tolerated in order to achieve sufficient persistence.