OBJECTIVE: Aim of present study was to identify factors affecting direct medical cost associated with statin therapy in Chinese patients at high risk of coronary heart disease (CHD). METHODS: Chinese patients at high risk of CHD who had been initiated on statin monotherapy for 12 months were recruited at the outpatient clinics of a public teaching hospital in Hong Kong. Patients' demographic information and clinical characteristics were collected at the entry of study. Patient adherence was assessed by the Medication Event Monitoring System over six months. The target types of healthcare resources included clinic visits, statin medications, laboratory tests on lipids and management of CHD events if any. Total direct medical cost per member per month (cPMPM) for each patient was calculated. A multiple regression model was used to identify demographic, clinical factors and patient adherence with significant association to cPMPM. RESULTS: 83 patients were included in the analysis. The mean age was 60 +/- 13 years and 51 (61%) of the patients were male. The median cPMPM of all 83 patients was USD43 (25th–75th percentile = USD38-45). Association between adherence levels and cPMPM was determined by backward multiple regression, controlling for other covariates. Nine factors identified by the model were male gender, monthly household income, primary education (<6 years), dose-time adherence to statins, history of diabetes mellitus, congestive heart failure, coronary atherosclerosis, coronary artery bypass graft and percutaneous transluminal coronary angioplasty. Male gender, history of diabetes mellitus, congestive heart failure and coronary atherosclerosis were significantly associated with higher consumption of healthcare resources. CONCLUSIONS: Male gender, history of diabetes mellitus, congestive heart failure and coronary atherosclerosis were significantly associated with higher consumption of healthcare resources. Adherence to statin therapy did not appear to affect the cost of treatment.