Audits of cholesterol management in patients with coronary heart disease (CHD) demonstrate that many patients do not achieve targets set out in national guidelines. Under-treatment is a component of the treatment gap and many patients are prescribed low-dose statins. The delivery of systematic care and adoption of more efficacious initial doses will increase the number of patients who achieve recommended low-density lipoprotein cholesterol (LDL-C) levels and maintain their LDL-C goals. Current studies indicate that rosuvastatin, atorvastatin and simvastatin are the most efficacious agents for lowering LDL-C and triglycerides. Compliance and persistence with statin treatment are poor and represent significant barriers to delivering mortality reductions in clinical practice. Efforts to improve concordance are necessary to ensure that treatment benefits are realised in clinical practice.