One of the risk factors for cardiovascular disease commonly seen in primary care is raised cholesterol. People are becoming more aware of the implications of lipid-lowering treatments, and are questioning the balance of treatment risk versus cardiovascular risk. At a time when prevention is becoming a priority in health care, it is increasingly important for patients to be counselled about cholesterol and future risk before lipid lowering therapy, to ensure compliance. This article aims to provide all the necessary information for primary health care professionals to feel competent in these discussions.