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Despite the established role of low-density lipoprotein cholesterol (LDL-C) as a major risk factor for cardiovascular disease (CVD), and the persistence of CVD as the leading cause of morbidity and mortality in the United States, national quality assurance metrics no longer include LDL-C measurement as a required performance metric. This clinical perspective reviews the history of LDL-C as a quality and performance metric and the events that led to its replacement. It also presents patient, healthcare provider, and health system rationales for re-establishing LDL-C measurement as a performance measure to improve cholesterol control in high-risk groups and to stem the rising tide of CVD morbidity and mortality, cardiovascular care disparities, and related healthcare costs., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Salim S. Virani reports a relationship with Department of Veterans Affairs, National Institutes of Health, World Heart Federation, Tahir and Jooma Family that includes: funding grants. Salim S. Virani reports a relationship with American College of Cardiology in his role as associate editor for innovations, acc.org that includes honorarium. Karen Aspry reports a relationship with Amgen, Esperion, Novartis, Ionis that includes: funding grants. Karen Aspry reports a relationship with National Lipid Association that includes: speaking and lecture fees. Dave L. Dixon reports a relationship with Boehringer Ingelheim Corp USA that includes: funding grants. Keith C. Ferdinand reports a relationship with Amgen, Novartis that includes: consulting or advisory. Elizabeth J. Jackson reports a relationship with Regeneron, Novartis that includes: consulting or advisory. Elizabeth J. Jackson reports a relationship with Esperion Therapeutics Inc that includes: consulting or advisory and speaking and lecture fees. Terry A. Jacobson reports a relationship with Astra Zeneca, Esperion, Novartis, Amgen, Regeneron that includes: consulting or advisory. Janice L. McAlister reports a relationship with Amgen Inc that includes: consulting or advisory and speaking and lecture fees. Janice L. McAlister reports a relationship with Esperion Therapeutics Inc that includes: speaking and lecture fees. Martha Gulati reports a relationship with Siemans that includes: speaking and lecture fees. Martha Gulati reports a relationship with Novartis, Bayer that includes: consulting or advisory. Christie M. Ballantyne reports a relationship with Abbott Diagnostic, Amgen, Arrowhead, Esperion, Merck, Novartis, Novo Nordisk, Regeneron, Roche Diagnostic that includes: consulting or advisory and funding grants. Christie M. Ballantyne reports a relationship with Akcea, Ionis that includes: funding grants. Christie M. Ballantyne reports a relationship with 89Bio, Alnylam Pharmaceuticals, Althera, Amarin, Astra Zeneca, Denka Seiken, Genentech, Gilead, Illumina, Matinas BioPharma Inc, New Amsterdam, Pfizer that includes: consulting or advisory., (© 2023 The Authors. Published by Elsevier B.V.)