OBJECTIVES: To investigate patterns of statin use in an Italian Local Health Unit (LHU) between 2002 and 2006. METHODS: Prescription records from Pieve di Soligo (Treviso) LHU were analysed during five years. Data of patients having at least one statin prescription were retrieved. Each prescription was linked to relevant patient code and identified by issue date, product name, package description, packages/prescription number and retail price. Patient's information consisted of gender and birth date. RESULTS: In total, 218,000 residents (4.7 % of Veneto Region) have NHS coverage through this LHU. Statin prescription concerned 8,107 patients in 2002 and 9,872 in 2006. Simvastatin was always the most commonly prescribed active principle accounting for 51% of prescription in 2002 (4 available molecules) and 37.7% in 2006 (6 available molecules). Overall statins utilization steadily increased from 50,212 prescriptions in 2002 to 61,917 in 2004. In 2004, a revision of prescription limitations caused a reduction in the number of patients eligible to free-of-charge medications, with a fall of total prescription to 47,719 and 46,118 in 2005 and 2006 respectively. Expenditure on statins increased from about €2.02Mio in 2002 to €3.21Mio approx. in 2004, showing a slight reduction to €3.09Mio in 2006. Average yearly per-patient expenditure showed limited variations (€249 in 2002, €298 in 2004 and €313 in 2006) due to changes in pack size, product mix and owing to repeated drugs' price cut. Median patient/prescription number and median number of packages/prescription were stable throughout the period. CONCLUSION: Statin prescription increase observed in early 2000s seems not to be directly influenced by the availability of active principles. Introduction of new reimbursement criteria markedly reduced prescription of lipid-lowering drugs at NHS charge. Indicators aiming at assessing specific appropriateness of statin prescriptions should be developed and periodic audits implemented.