Lowering cholesterol levels is a primary approach for reducing the risk of coronary heart disease (CHD), yet patients rarely achieve the lipid targets recommended by international guidelines. Although high rates of compliance and achievement of lipid targets have been reported in clinical trials, this situation is infrequently reproduced in regular practice. This sub-optimal lipid management has clinical consequences as patients will not gain the full benefit of treatment. Poor compliance with therapeutic lifestyle changes and/or lipid-lowering agents is thought to contribute to the failure of patients in clinical practice to achieve lipid targets, and therefore this problem needs to be addressed. Several approaches may be used to improve compliance, including the prescription of efficacious, well-tolerated agents, educating patients about the necessity of therapy, and regular follow-up to monitor compliance and achievement of goals. However, educating patients to promote compliant behaviour can be time-consuming and therefore the support of other health-care workers, where available, can prove invaluable. Compliance initiatives using educational materials, access to helplines and regular telephone contact with a qualified health-care worker may also improve adherence with therapy. Further studies into the causes of poor compliance and methods of improving adherence with lipid-lowering agents are required.