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Background Elevated low-density lipoprotein cholesterol (LDL-C) is a major risk factor for the development of cardiovascular diseases (CVDs), however a significant gap exists between the recommended guideline goals and the achievement of these goals in clinical practice. In addition, there remains suboptimal utilization of lipid-lowering therapies (LLT) (1,2). This study examines the prescribed LLT and the level of LDL-C goal achievements among Irish adults in a primary care setting. In addition, it identifies the patient factors associated with prescribing of LLT and LDL-C goal achievements.Methods This study is a cross-sectional analysis of the rescreen data of the Mitchelstown Cohort Study that occurred in 2015. Demographic, medication and diagnosis data were obtained from participant electronic health records. CVD risk was assessed using the SCORE tool. LDL-C goal achievements were determined using the LDL-C goals set out in the 2011 ESC/EAS guidelines for the management of dyslipidemia. A multivariate regression analysis was conducted.Results Among 1,183 participants, 48.5% were prescribed LLT, 42% of whom attained their LDL-C goals. Among very high-risk and high-risk participants, 20.8% were prescribed high-intensity statin and 32.6% of these achieved their LDL-C goal. Combination therapy was prescribed to 9.3% of participants. In multivariate analysis diabetes, polypharmacy and hyper-polypharmacy were associated with prescribing LLT. Being male or ≤59 years was associated with lower likelihood of LLT prescription. Target LDL-C goal achievement was associated with male sex and age ≤64 or ≥70 years while BMI 25–29kg/m 2 was associated with lower LDL-C goal achievement.Conclusion Dyslipidaemia is undertreated in this Irish primary care population with limited use of high-intensity statins. This study highlights the gap between guideline recommendations for LLT prescription and LDL-C target goals and real-world implementation of guidelines.