Diseases of the heart and vascular systems are the leading cause of death in the United States and worldwide. High-risk patients have been the focus of lipid-lowering trials and treatment guidelines, which recognize that more intensive reduction of low-density lipoprotein cholesterol is appropriate for a redefined, broader high-risk population. Lifestyle modifications and lipid-lowering drug therapy form the foundation of primary- and secondary-prevention programs for patients at moderate to very high risk. Evidence shows that despite the availability of effective agents, such as HMG CoA reductase inhibitors (statins), many patients still do not achieve low-density lipoprotein cholesterol goals. Nurse-centered case management programs that support early and continued adherence with lifestyle and medical therapies have been consistently successful at improving the rates of achieving lipid goals in high-risk patients.