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Background: In 2013, the ACC/AHA updated the cholesterol treatment guidelines. At the time, it was estimated that an additional 13 million Americans would quality for statin therapy. To date, the real-world implications of this guideline change have not been well studied. This study aims to better understand trends in statin use and adherence, by gender, and the impact of guideline change.Methods: This is a retrospective, observational study using medical and pharmacy claims from 2009 to 2014 from a large, national, commercial insurer. Considering all beneficiaries aged 18-65 with ≥1 year of continuous enrollment, we created annual cross sectional populations of statin-eligible patients and divided them into 3 statin benefit groups (SBG). In descending order of risk, the groups were: (1) atherosclerotic cardiovascular disease (ASCVD); (2) diabetes and (3) hyperlipidemia. Patients were assigned to the highest risk group that they qualified for.Results: Statin use rates among those with ASCVD increased until 2012 and then plateaued (Figure 1a). Use rates among those with diabetes, were flat until 2011 and then increased. Use rates among those with hyperlipidemia steadily rose from 2009-2014. Statin adherence rates among those with ASCVD increased from 2009-2014 (Figure 1b). Adherence rates among those with diabetes, decreased from 2009-2011 and then rose significantly from 2011-2014. Adherence rates among those with hyperlipidemia also rose steadily from 2009-2014. The most significant gender gap in treatment, for both use and adherence, was between men and women with ASCVD. There was with little change in this treatment gap, in any risk group, over the time period observed.Conclusion: The 2013 cholesterol guidelines have not yet had a significant effect on statin use or adherence. Recently improving trends in statin use and adherence, especially among patients with diabetes, appear to predate the 2013 guideline change. A significant gender gap in statin treatment remains, especially among those in the highest risk group.