Discordance between American guidelines and the "Swiss medical Board" position regarding treatment of dyslipidemia raised many questions. While benefits of statins are clear in secondary prevention, care should be individualised according to PROCAM cardiovascular risk score adapted to Switzerland in primary prevention. Lifestyle modification should be the first line therapy and a drug therapy is an option in high or intermediate risk, but not anymore in low cardiovascular risk. Familial dyslipidemia, often identified only after first cardiovascular event, should not be missed, as particular care is needed and riskscores cannot be used in this situation. Statins adverse effects remain a challenge in daily clinical practice.