Lowering low density lipoprotein (LDL) - cholesterol is one of the key issues in modern preventive cardiology by which we are able to interact with the natural course of atherosclerosis. Diet and healthy life style are mandatory for the treatment of CAD high risk patients. Numerous lipid lowering trials confirmed the beneficial effect of statins in primary as well as secondary prevention. By this statins are the basic treatment in patients with coronary artery disease (CAD) or diabetes mellitus or both. In order to reach LDL - cholesterol target levels (LDL - cholesterol < 100 mg/dl) in patients with CAD the use of potent statins or a lipid lowering combination therapy might be necessary. In our days we are able to lower LDL-cholesterol by more than 50% with drug treatment, which should enable us to reach the optimal LDL-cholesterol level in most patients.