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Background: Many adults are not at recommended lipid levels and the extent of treatment of dyslipidemia remains poor. We investigated the burden of cardiovascular risk and the distance of lipid fractions from the recommended targets by statin therapy and risk status in patients referred to a tertiary care lipid clinic., Methods: Assessment of cardiovascular risk factors was performed in 1657 patients, mostly dyslipidemics, referred by family physicians to our Lipid Clinic, 393 patients being under statin therapy. The shortfall of lipid fractions from the National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP-III) recommended goals was evaluated., Results: A high prevalence of cardiovascular risk factors was found. LDL cholesterol target was reached by 20% and 45% of untreated and statin treated patients, whereas non-HDL cholesterol target by 13% and 45% of untreated and statin treated patients, respectively. LDL cholesterol was over the goal by 27% in untreated patients and by 25% in statin treated patients. More than 40% and 65% statin treated patients were taking either a low statin dose or statins with low-to-moderate LDL cholesterol lowering efficacy (<30%). A decrease in the proportion of patients at target and greater shortfalls from recommended goals were found from low to high risk categories., Conclusion: The shortfall in reaching lipid targets, particularly among high risk statin untreated patients, may be partly explained by delayed or even inadequate lipid lowering therapy. Shortfalls in reaching the targets are not necessarily high and might be possibly managed at a primary care level., (Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)