LDL-cholesterol (LDL-C) levels are directly associated with the prevalence of coronary heart disease. Epidemiological and ecological studies have clearly shown that populations with LDL-C levels significantly lower than those found in western countries have a very low prevalence of coronary heart disease, despite the presence of other risk factors for atherosclerosis. It has been demonstrated that LDL-C reduction with statins not only reduces atherosclerosis progression but can induce its regression, if intensive LDL-C reduction, around 40–50%, is achieved. Most importantly there is a linear relation between LDL-C lowering and cardiovascular disease reduction; for each 1 mmol/L (39 mg/dL) there is ∼21% decrease in any major vascular event including death, myocardial infarction, stroke and myocardial revascularization as shown by a meta-analysis involving 90,056 patients who had participated in 14 statin trials. These findings were reinforced by another meta-analysis of more than 27,000 coronary heart disease individuals showing that intensive LDL-C lowering was superior to conventional therapy. Subjects considered to be at high risk by clinical stratification must be treated with intensive LDL-C lowering. Also, it has been proposed that asymptomatic subjects not considered at high risk by clinical stratification but otherwise presenting with a high subclinical atherosclerotic burden, must be treated in the same manner.