To identify risk factors associated with the decision to prescribe drug therapy within first year of diagnosis. METHODS: Selected all Patients diagnosed with hypercholesterolemia/ hyperlipidemia before October 1996 (so that patients are followed for one year) and who had serum lipid levels recorded prior to initial diagnosis from a electronic medical records database. Logistic regression analysis was the tool employed to evaluate the following factors: age, gender, serum lipid levels and comorbidities (hypertension, diabetes, coronary heart disease, obesity, and tobacco use disorder as a surrogate for smoking) and various combinations. RESULTS: The total number of patients included in the analysis was 3177, with 34.6% prescribed therapy within one year of diagnosis. For initial therapy, 79.6% were treated with statins, 6.0% with sequestrants, 10.1% with gemfibrozil, and 4.3% with niacin. Among those treated, 92.9% remained on therapies within the class of their initial treatment. Age, diabetes, HDL < 35 mg/dL, LDL ³ 190 mg/dL, CHD and LDL > 130 mg/dL, no CHD and either fewer than two risk factors with LDL ³ 190 or with two or more risk factors and LDL ³ 160, were positively associated with, and presence of tobacco use disorder was negatively associated with the decision to prescribe drug therapy within the first year (p=0.05). CONCLUSIONS: A range of factors influence prescription of antilipemic therapy during the first year after diagnosis. This decision has implications for resources devoted to patient management during the first year.