Guidelines for the prevention of cardiovascular disease (CVD) are greatly time-dependent owing to the rapid increase in knowledge in this important research area. However, at each point in time the knowledge base behind all guidelines on CVD prevention—for example, blood lipid modification, is common, international and easily available to all clinical scientists and opinion leaders engaged in the formulation of these guidelines. Nevertheless, they differ markedly between continents, countries and regions. There are several reasons for this: from factual differences in risk factor distribution between different populations to 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 the United Kingdom was issued (see page 1331).1 2 And last year 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.3 The joint European and NICE lipid modification guidelines thus are issued with essentially the same knowledge base. It is interesting to see how these two documents agree and differ. Patterns in the “guideline culture” are that local guidelines are adapted from more general ones—for example, national guidelines are adapted from …