OBJECTIVE: Cholesterol lowering has been shown to reduce cardiovascular morbi-mortality. National and international (e.g, US NCEP) guidelines have defined LDL-C treatment initiation levels (TIL) and goals for patients with different levels of coronary heart disease (CHD) risk according to the number of CHD risk factors (CRF) associated to dyslipidemia or to prior CHD. The objective of this study was to measure the proportions of patients above AFSSAPS (French Drug Agency) TIL [1 CRF > 220 mg/dl; 2 CRF>190 mg/dl; 3 CRFs > 160 mg/dl; >3 CRFs and prior CHD > 130 mg/dl] and NCEP goal in patients with different CHD risk level and treated with lipid lowering agents (LLA). METHOD: A total of 3173 Dyslipidemic patients managed by general practitioners were randomly selected from a French GPs computerized database. History of CHD and number of CRF (age, family history of premature CHD, smoking, hypertension, HDL-C <0.9 mmol/L, diabetes) were documented. Percent of patients above AFSSAPS TIL and NCEP goal was defined for each level of CHD risk. RESULTS: Twenty-one percent of patients had a history of CHD. Using AFSSAPS guidelines the distribution of primary prevention patients according to the number of CRFs (1, 2, 3, > 3) was 1.6, 25.5, 31.7 and 20.1 %, respectively. Almost 40% of CHD patients remained above TIL and the percentages of primary prevention patients above TIL varied from 3.9% for patients with 1 CRF to 46.5% for patients with > 3 CRFs (p <0.001). Using NCEP guidelines, percentage of patients not at goal in the different CHD risk categories were significantly higher and 74.3% of CHD patients were not at LDL-C treatment goal. CONCLUSION: Seventy-three percent of patients prescribed LLA were at high CHD risk. Increasing with CHD risk level, large numbers of patients were above TIL and LDL-C treatment goal. More effective interventions are needed in lipid lowering therapy.