Health care decision makers are increasingly forced to identify and implement the options for potential spendings and savings. Historically, preventive measures for cardiovascular diseases have been scrutinised a great deal. The main reason for this was that substantial financial investments would have to be undertaken long before the clinical benefits were apparent. In the past, most economic evaluations of lipid lowering therapy have been based on models combining logistic regression risk functions from epidemiological cohort studies, such as the Framingham study, with the extent of cholesterol reduction. Recently, however, data from the large controlled outcome studies (4S, CARE, LIPID, WOSCOPS) have been reported which allow a direct estimate of the economic benefits of cholesterol reduction in primary and secondary prevention. The economic evaluation of such therapies can be performed in several ways, from relatively easy cost-consequence analyses to more complex cost-effectiveness analysis. Initial economic analyses of the trials are already available. There are, however, still considerable practical and methodological issues which have to be taken into account in assessing lipid lowering drugs. Available pharmaco-economic data on lipid lowering therapies suggest that statins are a cost-effective option in primary and secondary coronary prevention.