OBJECTIVE: The purpose of this review was to examine the quality of lipid management in women with coronary heart disease (CHD) or at risk for CHD. More specifically, this review focused on cholesterol screening rates, treatment and LDL goal attainment in these high-risk patients. METHODS: Included for analysis were female patients enrolled in Oxford Health Plan with any of the following: 1) CHD; 2) other cardiovascular disease (CVD); 3) hypertension; and 4) age > 55 5) nicotine use. Patients were then reviewed for the presence of cholesterol screenings within the last 2 years, lipid panel results and whether or not they received cholesterol-lowering medications. RESULTS: There were 61,835 patients included for analysis; 23% had CHD, 9% had CVD, 42% had two or more CHD risk factors and 26% had only one CHD risk factor. Approximately 20-30% of patients lacked cholesterol screenings for the last 2 years, including patients with established heart disease, risk equivalents for CHD and risk factors for heart disease. Patients with target LDL levels <160 mg/dL and <130 mg/dL achieved goal at least two times more frequently than patients requiring LDL levels <100 mg/dL. Less than 25% of patients with CHD or CVD taking cholesterol-lowering therapy actually achieved LDL goal. For CHD/CVD patients not receiving cholesterol-lowering therapy, 40% were not at LDL goal. CONCLUSION: Overall, cholesterol screening rates, treatment and LDL goal attainment appeared to require improvement. Very few female patients requiring primary prevention for CHD reached LDL goal on cholesterol treatment indicating potential adherence deficiencies or a necessity to improve cholesterol-lowering regimens. Many high-risk patients were not at LDL goal nor on cholesterol therapy indicating a need to initiate cholesterol management in these patients. Currently, targeted strategies to improve cholesterol adherence, screening and prescribing practices are being examined at Oxford Health Plan.