Abstract Background and purpose Dyslipidaemia is a significant risk factor for cardiovascular disease in the Mexican population. This analysis aims to describe the baseline LDL-c levels of patients at cardiovascular clinics and evaluate the proportion of them who achieved their risk-based LDL-c goals as recommended by 2021 ESC prevention guidelines. Methods The REMECAR registry is an observational study of patients attending a specialized cardiovascular clinic for their first visit. The cardiovascular risk was retrospectively determined using the 2021 ESC guideline stratification and the SCORE2 and SCORE-OP. Results A total of 5,443 patients were included in the analysis. Within this population, 55.96% presented as very high, 39.98% as high and 4.06% as moderate to low risk. 63% of the participants were not on any lipid lowering treatment at entry, while 12.4% were receiving high intensity statin therapy. Patients presenting with established atherosclerotic cardiovascular disease had a mean LDL-c of 90.9±40.7 mg/dL. Of these, 14.1% were achieving LDL-c levels of 70–50 mg/dL and 19.3% were achieving LDL-c levels <55mg/dL (Figure 1B) In diabetic patients at very high risk, only 25.7% reached their LDL-c goal. Finally, in patients without another risk factor and very high-risk evaluated by SCORE2 & SCORE-OP, only 14% of patients achieved their LDL-c goals. Conclusions A significant number of patients were not receiving lipid lowering therapy. Furthermore, in those who were, a significant portion did not achieve LDL-c recommended thresholds. Our results underline the urgent need to improve the prescription and optimisation of lipid lowering therapy as the current management appears to be insufficient for achieving optimal recommended goals. Identifying key barriers in lipid management is fundamental to establishing better strategies and health system policies to reduce cardiovascular risk. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AMGEN