OBJECTIVES: To evaluate LDL cholesterol goal attainment among high risk CVD patients in Europe & US, and to assess the percentage of patients meeting US NCEP/ATP-III guideline's new criteria of <70mg/dl LDL for high risk patients. METHODS: CVD patient charts from outpatient settings were abstracted by primary-care physicians and specialists in US & Europe as part of a large multi-country research initiative. CVD patients with LDL cholesterol data from US and 5 major countries in Europe (EU5, reported in aggregate) in 2006 were included in this analyses and risk stratified into following 3 categories: High-risk (with coronary artery disease, myocardial Infarction, PCI/CABG, peripheral vascular disease, cerebral ischemia, diabetes (any-type)), Medium-risk (with >1 risk factors) and Low-risk (with 0 or 1 risk factors). Risk factors included: hypertension/low-HDL/age/sex/smoking/family-history of CVD. RESULTS: In total over 16,500 patients were evaluated (EU5 13,246 and US 3,597). Distribution of patients for EU5 and US respectively were – High-risk: 9617 and 2615, Medium-risk 3093 and 768, and Low-risk: 536 and 214. Percentage of patients at different levels of LDL (mg/dl) in EU5/US were – High risk <100: 31.0%/49.0% 100-to-<130: 35.4%/34.1%, 130-to-<160: 23.4%/11.3%, >=160: 10.1%/5.5%; Medium-risk in EU5/US <100: 17.0%/29.6%, 100-to-<130: 34.9%/47.8%, 130-to-<160: 32.0%/16.8%, >=160: 16.0%/5.9%, and among Low-risk groups (EU5/US): <100: 15.5%/29.0%, 100-to-<130: 34.7%/40.7%, 130-to-<160: 34.5%/25.7%, >=160: 15.3%/4.7%. Evaluation of patients at LDL<70mg/dl within the High-risk group per NCEP/ATP-III guideline recommendations revealed that only 8.8% & 13.7% met the criteria in EU5 & US respectively. CONCLUSION: Almost two-thirds (EU5) and one-half (US) of High-risk CVD patients did not meet the LDL<100mg/dL goal in 2006. Further, patients in EU5 appear to considerably lag behind those in the US in every CVD risk level (in LDL goal attainment), contributing to disproportionate disease burden in respective market segments.