Unfortunately, lipid-lowering drug therapy remains underutilized in clinical practice, and few secondary prevention patients achieve the low-density lipoprotein (LDL) cholesterol level (< or = 100 mg/dl) recommended by the National Cholesterol Education Program. To improve patient management, a telephone-based computerized system primarily managed by dietitians was implemented in one of our cardiology clinics. Lipid results from all lipid and cardiology referrals and patients admitted to the cardiology service at 1 hospital are managed through this system. Patients are contacted via computer-generated postcards and the dietitians every 3 to 6 months. At baseline (September 1, 1994, through August 31, 1995; n = 1,969), 34% and 66% had LDL cholesterol < or = 100 and < or = 130 mg/dl, respectively. By September 1, 1997, to August 31, 1998 (n = 2,827), the proportion of patients with LDL cholesterol < or = 100 mg/dl had increased to 61%, and 89% had LDL cholesterol < or = 130 mg/dl. Statin use increased from 47% to 85% of patients. By 1997 to 1998, 74% and 40% of patients received statin doses that would, on average, produce a 34% and 41% reduction in LDL cholesterol, respectively. Whether a patient had LDL cholesterol < or = 100 mg/dl was not predicted by patient characteristics, drugs given, or by medication insurance coverage.