All patients with cardiovascular disease (CVD) should be offered drug treatment to reduce their cholesterol levels without waiting for the management of modifiable risk factors, recommends the latest guidance on lipid modification from the National Institute for Health and Clinical Excellence (NICE). The much-anticipated guideline finally puts to bed the ‘5 and 3’ or ‘4 and 2’ debate over cholesterol levels for primary and secondary prevention. In this article, we review what the guidance says about lipid lowering in secondary prevention.