OBJECTIVES: Clinical trials have demonstrated improved outcomes in patients receiving cholesterol lowering medications (CLM) following coronary revascularization and clinical guidelines recommend aggressive cholesterol lowering therapy for patients with established coronary disease. However, in routine practice, the degree to which these recommendations are followed and their impact are unknown. METHODS: Using administrative databases, we examined the use of CLM in a consecutive cohort of 11,985 elderly (average age 71.4) patients undergoing coronary revascularization from 1995 until 1997 in Quebec, Canada. RESULTS: Before revascularization, 30.9% were receiving CLM. After a 3-year follow-up, 62.8% of cohort survivors had received at least 1 prescription for CLM. CABG patients had a decreased probability of receiving CLM compared to PCI patients (OR .75 95% CI .72-.79). High-risk patients especially the very elderly (>75) had a significantly decreased probability of receiving CLM (OR .61 95% CI .57-.66). The most potent predictor of a post-operative prescription use was pre-operative utilization (OR 7.1 95% CI 6.8-7.5). An adjusted time-dependent analysis showed that patients receiving CLM had a lower risk of death (RR 0.61 95% CI 0.52-0.79) or myocardial infarction (RR 0.78 95% CI 0.64-0.93) than those not exposed to these drugs. There was no difference in the need for a repeat revascularization between the groups (RR 1.05 95% CI 0.91-1.20). CONCLUSIONS: CLM were underused in this post revascularization population and this underuse was associated with an increase in adverse outcomes.