Background Monitoring low-density lipoprotein cholesterol (LDL-C) and prescribing appropriate treatment is crucial for secondary prevention in primary care. Aim To study LDL-C levels and treatments for patients with ischaemic heart disease according to target recommendations and assess factors influencing prescribed drug intensity. Design & setting A cross-sectional study was undertaken. We examined electronic health records of patients with ischaemic heart disease from three primary care centres in Spain. Method LDL-C levels were assessed using the most recent registry, and LDL-C-lowering treatments were categorised by their theoretical efficacy. Factors associated with LDL-C target attainment were analysed using univariate and multivariate regression models. Prescription intensity was studied with ordinal logistic regression models. Results We studied 1936 patients, 14.88% of whom received no LDL-C-lowering treatment. The percentages of patients who achieved LDL-C thresholds of<70 mg