We have read with interest the article published by Galve et al.1 in Revista Española de Cardiología concerning the degree of lipid control in patients with coronary artery disease. The authors report an observational study in which they found that poor control of low-density lipoprotein cholesterol (LDL-C) levels has been reported constantly in recent years, a situation that we believe should prompt reflection. There is a great deal of scientific evidence that associates LDL-C levels with the development of new cardiovascular events in patients with coronary artery disease. This evidence has led the current clinical practice guidelines2 to consider the achievement of LDL-C levels < 70 mg/dL in these patients to be a class Ia recommendation. However, barely 1 in 4 patients achieves that therapeutic target, even with lipid-lowering therapy.1,3,4 In the treatment of patients with coronary artery disease, other therapeutic strategies with a class I recommendation—primary angioplasty or the use of dual antiplatelet therapy—reach much higher rates of compliance with therapeutic goals. We believe this could be due to the difference in the time it takes for the benefit to be observed; whereas the benefit observed with percutaneous treatment is practically immediate, lipid control requires proper treatment adherence for its beneficial effect on mortality and morbidity to become apparent. Although the achievement of optimal LDL-C levels reduces cardiovascular mortality by an additional 20%,5 Galve et al.1 found that lipid-lowering therapy was modified in only 26% of patients with poor LDL-C control. This finding suggests that, in general, scant attention is paid to this very important parameter of secondary prevention. In addition, another factor associated with poor LDL-C control may be individual variation in the response to lipid-lowering therapy. A recent communication reported that at least half of the patients treated with high-intensity statin therapy achieve a reduction in LDL-C > 50%, but that 10% of those patients show no change or even an increase in LDL-C levels.6 Given the resulting prognostic benefit, it is essential to optimize LDL-C concentrations in most patients with coronary artery disease, a fact that has been reflected in the recent document of the Spanish Society of Cardiology dealing with quality indicators in cardiology.7 On the other hand, subtilisin/kexin 9 inhibitors, with a presumed lower variation among the responses of the different groups and a reduction in LDL-C > 60% compared with baseline,8 could help to improve lipid control. The inclusion of these patients in cardiac rehabilitation programs helps to optimize secondary prevention parameters and, thus, to reduce morbidity and mortality rates. This strategy is categorized as a class Ia recommendation in recent guidelines on cardiovascular disease prevention.2 For this reason, it should be applied in most of our patients.