OBJECTIVES: To assess the attitudes and beliefs of physicians about hypercholesterolemia and its treatment in Spain. METHODS: An observational, cross-sectional questionnaire survey was performed in 2006. 22 cardiologists, 23 endocrinologists, 22 internists and 21 primary care physicians were included. Their attitudes and beliefs about hypercholesterolemia and its treatment were assessed by means of 7-items Likert scales and ordinal categorical variables. RESULTS: Eighty-eight physicians were included in the study, 77% were over 40 years of age and mainly working in urban areas (82%). A total of 97.7% agreed that national guidelines and target levels for LDL-c management are clear, and 11.5% considered they are difficult to apply due to the frequent changes in the LDL-c target level. A total of 48.2% agreed that statin monotherapy is sufficient to make most of patients get to LDL-c goal and, for patients not reaching LDL-c goal, 82.7% agreed they would consider trying a combination therapy, 81% increasing the statin dose, and 21.7% switching to another statin. When they were asked to state the most frequent reason that made patients with lipid-lowering therapy not getting to cholesterol goal, 60.2% referred to the patient's lack of compliance, 35.2% to the lack of compliance with diet/exercise, and 31.8% to the insufficient dose or efficacy of pharmacologic therapy. A total of 63.2% agreed that compliance is reduced because patients take too many drugs, and 97.7% agreed that fixed dose of combination therapies would increase patient compliance. CONCLUSION: Despite the high degree of knowledge about the recommendations for LDL-c target levels among physicians and the limited additional efficacy obtained by titrating the statin dose, over half of physicians believe that statin monotherapy is enough to achieve LDL-c target levels, and mainly attribute to the patient's lack of compliance the low proportion of patients achieving LDL-c target levels.