The recently published National Cholesterol Education Program (NCEP) III guidelines expands the number of US adults eligible for drug therapy to treat or prevent coronary heart disease from 13 million to 36 million. This is largely owing to an expansion of the definition of prior cardiovascular disease to include all occlusive events of the heart, brain, and peripheral arteries; the use of global risk assessment rather than just lipid parameters; and elevation of diabetes mellitus to a coronary heart disease risk equivalent. For patients with prior events as well as those with diabetes or a 10-year risk of 20% or greater, the low-density lipoprotein cholesterol (LDL-C) goal is less than 100 mg/dL (<2.59 mmol/L). For those without a prior event or diabetes and 10-year risk of 10% to 19%, the LDL-C goal is less than 130 mg/dL (<3.36 mmol/L), and for those with a 10-year risk less than 10%, the LDL-C goal is less than 160 mg/dL (<4.14 mmol/L). Drug therapy, primarily using statins, either alone or in combination, should be an adjunct, not alternative, to therapeutic lifestyle changes. The statin drugs decrease risk of myocardial infarction, stroke, cardiovascular death, and total mortality. Statins have the most conclusive body of evidence to support their use to favorably alter lipid levels, including their benefit-to-risk and benefit-to-cost ratios, so their increased use in accordance with the new NCEP III guidelines could avoid tens of thousands of premature deaths in the United States each year.