According to national and international guidelines, the target serum low-density lipoprotein (LDL) cholesterol (LDL-C) level in secondary prevention of coronary heart disease is < 100 mg/dl. The EUROASPIRE-II study has clearly shown that this goal is far from being achieved in daily practice. The aim of the present study was to look at the distribution of LDL-C in 661 patients with CHD participating in outpatient exercise groups for cardiac rehabilitation. Although this preselection should have resulted in a sample of relatively well-guided and informed patients, 67% (58% with lipid-lowering drugs [LLD] and 78% without LLD) did not show the target LDL-C < 100 mg/dl. In a subgroup analysis, we investigated the influence of items such as physical activity (PA), BMI, and dosage of LLD on LDL-C. As expected, patients taking high doses of LLD (equivalent to 20 mg atorvastatin) showed lower levels of LDL-C as well as those exhibiting a higher degree of PA (3 times PA/w) and a lower BMI (<27). Nevertheless, each factor alone was not sufficient to achieve a mean LDL-C level beyond 100 mg/dl. Only in patients showing the combination of all three factors was mean LDL-C lower than 100 mg/dl (94 mg/dl). These results demonstrate that the target level for LDL-C is not attained by the majority of patients participating in outpatient exercise rehabilitation groups and that a multifaceted approach, including adequate drug therapy as well as lifestyle interventions, is necessary to achieve the desired LDL-C level.