The efficacy of lipid-lowering agents such as HMG CoA reductase inhibitors (statins) in reducing mortality and morbidity in patients with coronary heart disease (CHD), or risk factors for CHD, has been well established in a number of large clinical trials. However, sobering results emerged at the 47th Annual Scientific Sessions of the American College of Cardiology [Atlanta, US; March 1998], indicating that lipid-lowering agents are being vastly underutilised in the patients who stand to benefit the most. Data concerning the enormity of the problem, and data pointing to factors associated with the underutilisation of lipid-lowering therapy, were presented at the meeting.