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Atherosclerosis contributing to cardiovascular disease is the leading cause of death in the United States. It is also the major cause of peripheral arterial disease (PAD). Although there is substantial evidence that aggressive treatment of hyperlipidemia improves the outcome of patients with coronary artery disease (CAD), relatively little attention has been directed toward lipid control in patients with PAD. The National Cholesterol Education Program (NCEP) has established guidelines for treatment of lipids in patients with atherosclerotic disease. The purpose of this study was to determine the effectiveness of current lipid management practices in patients electively admitted for peripheral vascular surgery and to explore methods to improve compliance with NCEP guidelines. The past medical/surgical history, risk factors for atherosclerosis, and medication regimen including lipid medications were obtained from a retrospective review of the medical records of 105 consecutive patients scheduled for an elective vascular procedure. Lipid profiles were obtained as part of their routine preoperative assessment and the results were compiled and compared with established NCEP guidelines to determine the level of compliance in our PAD population. Eighty-five of the 105 patients had lipid profiles recorded in the medical record. Only 42% of patients were at or below the recommended goal of less than 100 mg/dL for low-density lipoprotein (LDL). Greater than half of patients had previous diagnosis of atherosclerosis or had previous bypass including coronary artery bypass surgery. Despite the strong emphasis on lipid reduction, especially LDL cholesterol, only a minority of patients admitted for peripheral vascular surgery were at the recommended NCEP goal. More aggressive evaluation and treatment of lipid disorders in patients with PAD seems warranted.