Background: The purpose of the present study was to examine physician’s attitudes and practices toward the use of different lipid-lowering management strategies in patients at increased risk for coronary heart disease (CHD). Aims/Methods: An internet-based questionnaire was completed by 78 general internists and family practitioners (mean age = 49 years; 80% male) affiliated with a large primary care health delivery system in Connecticut. Questions were asked about physician knowledge and use of current national guidelines for lipid-lowering therapy and their treatment practices for patients at varying risk for CHD. Results: Most physicians reported they were very knowledgeable about different interventions to lower serum lipids. Most (92%) indicated that they were aware of and followed national guidelines for the treatment of patients with hyperlipidemia the majority of the time. Physicians were likely to initiate lipid-lowering therapy at lower levels of serum LDL cholesterol in patients at high, as compared to those at moderate, risk for coronary disease. Targeted treatment levels were also reported to be considerably lower for patients at higher risk, than for those at moderate risk, for the development of coronary disease. Diabetes, cigarette smoking, and elevated LDL cholesterol levels were reported to be the three most important risk factors for CHD by the physician sample. Gaps in the recommendation of lifestyle changes to patients with hyperlipidemia were observed. Conclusions: Despite adequate physician knowledge, achieving desirable serum lipid levels in primary care patients remains elusive. Provider education is needed to optimize the care of patients with elevated serum lipids treated in the primary care setting.