OBJECTIVE: To assess relative success rates and resource utilization differences between males and females treated to NCEP and EAS cholesterol goals with HMG-CoA reductase inhibitors. METHODS: In three open-label clinical trials in the US and Europe, 998 patients (375 females and 623 males) with a CHD risk factor, documented CHD and/or PVD, were randomized to receive one of five HMG-CoA reductase inhibitors (atorvastatin, fluvastatin, lovastatin, pravastatin, or simvastatin). Physician visits occurred every 6 weeks and dose titrations (either increased statin dose, or the addition of colestipol or cholestyramine) were made every 12 weeks if target LDL-C concentration levels were not achieved. The analysis takes a third party perspective by using insurance payment rates for study medications, physician visits, add-on therapies and treatments for adverse events, all denominated in 1997 US dollars. RESULTS: NCEP or EAS LDL-C targets were achieved with similar frequency by males (75.7%) and females (74.7%). Accordingly, resource utilization was similar for males and females. Mean total costs were similar for all males ($1529.94) and females ($1470.99, p=0.776); males ($1280.62) and females ($1252.95, p=0.665) reaching goal and males ($2306.32) and females ($2115.59, p=0.103) not reaching goal. Finally, mean total costs for males and females (and respective percentages achieving LDL-C targets) were similar among study medications: atorvastatin $1044.49 (88.2%) and $1020.29 (90.7%); fluvastatin $1815.03 (58.4%) and $1709.72 (55.5%); lovastatin $2031.78 (77.9%) and $2045.43 (80.3%); pravastatin $1878.90 (53.6%) and $1776.19 (35.7%) and simvastatin $1475.48 (80.3%) and $1293.43 (77.0%). CONCLUSIONS: Successes in achieving LDL-C targets and resource utilization were independent of gender. However the ability to reach target LDL-C, by use of specific study medications, significantly impacts the total cost of cholesterol reduction.