Background. In clinical practice, most coronary artery disease patients are not achieving their recommend LDL-cholesterol goal of <70？mg/dL. Methods. We conducted a retrospective analysis of outpatient electronic health records and the most recent lipid profile, lipid-lowering medications and doses were collected. Results. We identified 9950 coronary artery disease patients. Only 37% on a statin alone achieved an LDL-cholesterol of <70？mg/dL, and most were on moderate-to-high-potency statins. The intensity of statin therapy did not improve LDL-cholesterol goal attainment. Among patients on combination therapy, 41% on statin plus ezetimibe and 46% on statin plus niacin achieved an LDL-cholesterol of <70？mg/dL ( and <0.0001 versus statin alone). If patients were switched to a high-potency statin LDL-cholesterol goal attainment of <70？mg/dL would increase to 46% and would increase up to 72% with combination therapy. Conclusions. Most coronary artery disease patients in clinical practice do not attain an LDL-cholesterol of <70？mg/dL, even among patients on high potency statins. The combination of statin plus either ezetimibe or niacin is the most effective regimen to achieve an LDL-cholesterol of <70？mg/dL, however, these drug combinations are used infrequently in clinical practice. 1. Introduction Coronary artery disease (CAD) is the leading cause of death and disability in both men and women in the United States [1]. Patients with known CAD are considered at high or very high cardiovascular risk and require aggressive modification of all their risk factors [2]. Several major clinical trials with statin therapy in patients with CAD have shown that lowering low-density lipoprotein (LDL) cholesterol can reduce cardiovascular events and the lower the LDL-cholesterol achieved the lower the cardiovascular risk [3–7]. In the Cholesterol Treatment Trialists’ (CTT) Collaboration meta-analysis of individual data from over 170,000 patients in 26 randomized trials of statins, coronary mortality was reduced by just over one-fifth per 1.0？mmol/L (or 39？mg/dL) reduction in LDL-cholesterol with no evidence of any threshold within the range of cholesterol studied [8]. In a recent analysis from the JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial of Evaluating Rosuvastatin) trial, individuals who achieved an LDL-cholesterol of <50？mg/dL had a lower cardiovascular risk than those with higher on-treatment levels of LDL-cholesterol [9]. Based on a wealth of clinical trial evidence, current guidelines now recommend more aggressive
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