Coronary heart disease remains the number one cause of death In the American population. The Framingham Heart Study and other epidemiologic studies have demonstrated a direct relationship between elevated total and low-density lipoprotein cholesterol in the development of cardiovascular disease. This article focuses on secondary prevention, demonstrating that decreased cholesterol has a wide range of benefits in patients with cardiovascular disease. Emphasis is placed on the Scandinavian Simvastatin Survival Study which reported a 30% reduction of total mortality in a population of 4,444 patients with coronary heart disease who were treated with an HMG-CoA reductase inhibitor. The National Cholesterol Education Program guidelines for cholesterol risk reduction are reviewed. The Impact of the health care provider as related to adherence and medication is discussed. Outcome issues of cost-effectiveness and resource utilization relating to cholesterol reduction are emphasized.