Background: Statin treatment is routinely used for secondary prevention world-wide. Little is known about the prevalence of persistent lipid abnormalities under chronic statin treatment for secondary prevention and possible differences in LDL-Cholesterol (LDL-C) goal attainment in clinical practice between countries in different parts of the world. Methods: Between 2008 and 2012, consecutive statin-treated outpatients were enrolled in 26 countries worldwide, (DYSIS = Dyslipidemia International Study; list of countries in table) to assess LDL-C goal attainment for secondary prevention. European Society of Cardiology recommendations were used to classify patient risk, and to define LDL-cholesterol treatment goals. Data were collected under real life conditions in physicians’ offices and hospital outpatient wards. Results: Serum lipid values of 57,885 consecutive statin-treated outpatients were studied in the context of their cardiovascular risk factors, and the potency and composition of their lipid-lowering treatment. In the very-high risk patients only 21.7% did reach the currently recommended LDL-Chol target <70mg/dl with large differences between the countries varying from 9.2% to 44.3%. In the high-risk population the LDL-Chol target <100mg/dl was achieved in 38.0% oft he patients, varying between 16.6% and 66.7% between countries Conclusion: Despite chronic statin treatment, only 21.7% of the very-high-risk patients reached the current recommended LDL-Chol target <70mg/dl in this large multinational cross-sectional trial, highlighting the persistent large gap between guideline recommendations and clinical practice. Further treatment escalations are necessary to reduce the risk of subsequent cardiovascular events.