OBJECTIVE: It is known that initiation of drug therapy for hypercholesterolaemia once diagnosed, is improving and now stands at around 60%. What is unclear is whether there is a delay between patients being identified with elevated cholesterol and a subsequent diagnosis of hypercholesterolaemia. To address this uncertainty, this database study followed patients with an initial recording of cholesterol greater than 5mmol/L, through diagnosis and advice to treatment. METHODS: The DIN-LINK database, containing anonymised medical records from 1.5 million patients collected via GP practice computers, was used to identify and follow-up a cohort of patients with a recorded cholesterol level greater than 5mmol/L. For inclusion, each patient had to have a baseline measurement taken between April 2001 and April 2002, a minimum of 12 months follow-up data and not been diagnosed with hypercholesterolaemia or be prescribed cholesterol lowering medications prior to the cholesterol measurement. RESULTS: A total of 3418 patients were identified as meeting the criteria. Of these, 991 (29%) were diagnosed as hypercholesterolaemic within 12 months, three-quarters of these on the same date as the recording of the elevated cholesterol. Of the initially identified 3418 patients, only 257 (8%) were prescribed cholesterol lowering medication within 12 months of the initial reading. CONCLUSIONS: For patients who are known to have elevated cholesterol 71% fail to receive a diagnosis of hypercholesterolaemia and 92% do not receive medication within 12 months of initial reading. Further analyses are required to determine the impact of these delays in diagnosis on patient outcomes.