Current guidelines emphasise the importance of lipid management in secondary prevention of coronary heart disease (CHD). This audit of lipid levels and lipid-modifying therapy was undertaken in 1,736 patients, 919 men and 817 women, who were either attending a lipid clinic in inner-city Britain (n=1,035, 60%) or a general practice surgery covering 9,500 patients (n=701, 40%). Patient data were obtained from review of case notes and latest results for serum total, low-density lipoprotein (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were categorised in accordance with UK guideline targets (total cholesterol < 5 mmol/L, LDL-C < 3 mmol/L and HDL-C > 1 mmol/L). Overall, 48% of men and 61% of women had raised total cholesterol levels above target and 23% of men and 8% of women had low levels of HDL-C; these proportions were generally consistent for individual centre data. Amongst patients with established CHD who were receiving statin therapy, 31% of men and 47% of women had raised total cholesterol levels above target and 24% of men and 8% of women had low HDL-C levels. This suggests that a substantial proportion of patients at risk of developing or with established CHD, either attending general practice or a specialist lipid clinic, fail to meet recommended lipid targets. Redress of this failure requires more aggressive management, possibly with multidrug lipid-modifying therapy.