AbstractObjective To describe real-life patterns of statin use and cholesterol goal attainment in a retrospective cohort of patients with high cardiovascular risk. Methods Retrospective cohort study of 21,636 individuals, 18.34% women, mean age 63.30y (SD 6.29). New statin users aged 35-74y at high cardiovascular risk and with no previous cardiovascular disease in primary care electronic medical records (2006-2011). Patterns of statin use were based on statin type, potency and 1-year statin switches. Outcomes relative mean reductions over 1 year and probability of goal attainment (<3.3 mmol/L). Natural patterns of statin use were identified using multiple correspondence analysis; general linear and logistic models were used to estimate LDL-cholesterol reductions and goal attainment probability. Results Three patterns of statin use were defined: low (3.82% of the population), moderate (71.94%) and high intensity (24.24%). After 1 year, potency decreased 42.74%, 64.16% and 50.94%, respectively, and 37.41%, 29.47% and 30.16% of the population stopped taking statins in low, moderate and high patterns, respectively. Relative reductions in LDLcholesterol: low intensity, 15.7% (95%CI: -22.96-54.36), moderate intensity, 29.72% (95%CI: 29.12-30.32) and high intensity, 24.20% (95%CI: -8.08-40.32). There was a direct relationship between higher intensity patterns and greater probability of goal attainment. Conclusions Three real-life patterns of statin use were identified. Lipid management strategies in primary care should focus on improving adherence to treatment. People starting at low potency should switch to a moderate pattern; more intensive therapies should be considered in who require a larger LDL-cholesterol reduction to reach therapeutic targets, patients with good treatment adherence who do not achieve the goal with a moderate pattern of therapy or patients at very high risk.