OBJECTIVES: To assess the effects of increasing the statin potency in the management of hypercholesterolemia in general practice and cardiology outpatient settings in Germany. METHODS: A total of 603 randomly drawn patients from 62 selected general and cardiology practices in Germany. All patients had established coronary heart disease, initiated on lipid-lowering therapy (LLT) between July 1, 1998 and June 30, 1999, had at least one LDL-C measurement in the preceding year and were treated for secondary prevention for at least two years (or until the patient’s death) after LLT initiation. Out of 603 patients, 153 had a final switch to a higher potency statin (either the same statin or a different one) and are analyzed here. RESULTS: The 153 patients had a mean baseline LDL-C of 170.8 mg/dL, mean age of 63 years, mean baseline TC of 263.8 mg/dL, 42% were females and 31.3% were diagnosed with diabetes mellitus. The mean pre-switch LDL-C was 143 mg/dL, mean post-switch LDL-C was 126.6 mg/dL, mean percentage reduction was 7.8%, and the mean time before the final switch was 143.6 days (median 80 days). In a paired comparison test, the reduction in post-switch LDL-C was significant at < 1%. In a multivariate analysis, the time to switch to higher potency after LDL-C measurement has no significant effect on post-switch LDL-C reduction. After switch 42 (27.45%) attained goal LDL-C level. CONCLUSIONS: Switching to higher potency statins reduces LDL-C levels by only an additional eight percent (8%) resulting in majority (72.55%) of the patients in clinical practice failing to attain recommended LDL-C goal even after up titration on statins.