Several randomized placebo-controlled prospective trials have demonstrated the preventive and therapeutic role of intensive lipid lowering therapy in primary and secondary prevention of atherosclerotic disease. The NCEP ATPIII 2004 guideline recommended intensive low density lipoprotein cholesterol (LDL-C) lowering with target level of 70mg/dl in very high risk acute coronary syndrome patients or established coronary artery disease with multiple risk factors patients. However, lowering cholesterol by statin did not improve survival n several categories of diseases such as heart failure or renal failure. Recent study (Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis) even shows higher incidence of cancer in lipid lowering arm. The debate of lipid lowering was still controversial. We will summary the recent evidenced based trials and try to highlight this issue. In addition to the debate, we will present the current status of hyperlipidemia management in Taiwan. Carotid atherosclerosis will also be evaluated by different imaging modalities by the cardiologist and radiologist.