Guidelines for the prevention of cardiovascular disease (CVD) are greatly time-dependent due to the rapid increase of knowledge in this important research area. However, at each point in time the knowledge base behind all guidelines on CVD prevention e.g. blood lipid modification is common, international, and easily available to all clinical scientists and opinion leaders engaged in the formulation of those guidelines. Nevertheless they differ markedly between continents, countries and regions. There are several reasons for this: not only factual differences in risk factor distribution between different populations but also local customs and traditions and individual influences from scientists and clinicians involved in the authorship of the guidelines. Recently a new guideline for Lipid Modification by the National Institute for Health and Clinical Excellence in UK was issued (NICE-LMG) (Give actual reference here!). Close in time the Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine European societies and by invited experts) issued their guidelines . The Joint European and NICE Lipid Modification guideline thus are issued with essentially the same knowledge base. It is of interest to see how these two documents agree and differ. Patterns in the “guideline culture” are that local guidelines adopt from more general ones, e.g. national guidelines adopt from European guidelines. Also, the closer the authors are to the health care provider, the more restrictive they seem to be in recommending more comprehensive (and more expensive) diagnosis, treatment and follow-up. One fact that could modify more local guidance from general is of course also professional specialty of the members of the development group. In the NICE-LMG there is a preponderance of general practitioners and that has its impact on the present document.