OBJECTIVES: Achieving combined optimal lipid values (OLVs) for LDL-C, HDL-C, and triglycerides (TG) is associated with reduced cardiovascular events; however little is known about the subsequent loss of OLV. This study evaluated the loss of OLV and associated cardiovascular events in a managed care (MCO) population. METHODS: Patients were selected from a 2.1 million record database based on: lipid panel between January 1, 2000 and December 1, 2001, no concomitant lipid therapy, and continuous eligibility for 24 months. Patients were categorized as 1°/2° prevention, male/female, and diabetes mellitus (DM). Guidelines defined OLVs: NCEP ATP III (1° and 2° prevention, men), AHA (women), and ADA (DM). Combined OLV achievement was determined, as were cardiovascular events based on ICD-9/CPT codes. The association between loss of combined OLV achievement and cardiovascular events was evaluated by multivariate logistic regression and calculated odds ratios (OR). RESULTS: The study included 44,351 patients: 1° prevention (23,403); 2° prevention (20,948); males (22,345); females (22,006); and DM (8,164). Mean age was 64±13 years, with a follow-up of 30±12 months. Baseline lipids (mg/dL): total cholesterol 210±40; LDL-C 131±35; HDL-C 48±14; and, TG 159±77. Baseline combined OLV was achieved in 8-13%, which increased to 17-21 % during follow-up. There were 10,899 cardiovascular events experienced in 6,722 patients. Loss of combined OLV was associated with an increase in cardiovascular events in the total population (OR 1.43, 95% CI, 1.30-1.57). Subgroups demonstrated a similar increase in events (OR: 1.40 to 1.67; 95% CI, 1.28 to 1.88) except 1° prevention (OR, 1.2; 95% CI, 1.0-1.3). CONCLUSION: Combined OLVs were achieved by <25% of patients. Loss of combined OLV achievement was associated with a significant 40 to 67% increase in cardiovascular event risk, excepting 1° prevention patients. Maintaining combined OLV achievement has the potential to significantly improve outcomes across a wide spectrum of patients.