The observation that coronary heart disease was greatest in those individuals with the highest cholesterol levels resulted in the development of interventions to lower cholesterol to improve coronary risk status. Some individuals will achieve target lipid levels with diet and lifestyle modification alone. Therefore, diet and lifestyle modification is the preferred initial treatment. For more aggressive management of those who do not respond to diet and lifestyle modification or who have documented coronary heart disease, lipid-lowering drugs, extensively tested in large, multicenter, randomized clinical trials are preferred. Initially, questions arose about adverse effects of lipid-lowering drugs, but continued use has demonstrated that these drugs are both safe and efficacious. The need remains, however, for clinicians to monitor each patient's response to lipid-lowering diets, lifestyle modification efforts, and drugs and evaluate whether beneficial effects outweigh the cost and potential for adverse effects.