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Since 2011, the European guidelines have included a specific low-density lipoprotein cholesterol (LDL-C) target, 70 mg/dl, for very high cardiovascular risk (CVR) patients. However, registries have shown unsatisfactory results in obtaining this level of adequate lipid control. To assess temporal trends in the use of lipid-lowering therapy (LLT) and attainment of adequate control in very high CVR patients since 2011. We performed a retrospective observational study including very high CVR patients admitted in two periods the first tw