Background: Many high-risk patients in need for primary and secondary prevention of cardiovascular disease (CVD), are under-evaluated and under-treated.We have previously demonstrated that in the "real word" 4C intervention of secondary prevention of dyslipidemia based improve secondary prevention measures reduce cardiovascular rehospitalizations.A national wide, primary and secondary prevention computerized system was lunched on 2007 in the "Clalit Health Services" HMO.Aim:To evaluate CVD prevention status among high-risk patients for CVD events, and evaluate physician compliance with computerized recommendation for CVD prevention.Methods: Computerized records, laboratory data and drug prescriptions were used to identify patients at high-risk for CVD using an automatic risk-profile processor based on the presence of diabetes, the European "Score" and the "Framingham" index.Current guidelines adopted were used to generate clinical recommendations.Patients, aged 30-74y who visited primary care clinics of Clalit H.M.O.throughout 1-2007 to 8-2009 were included.Results: During a 22 months period 1,625,633 patients were evaluated by 4C-N processor; 16,7% (273,320) were considered as high risk CVD of which 70% were enrolled for the intervention.The main reasons for patients enrollment were the presence of CVD (30%), Euro Score >5 (35%), the presence of diabetes (33%) and Framingham score >20% (2%).Most of patients (87.6%) were enrolled within the first 18 month of the intervention activity.Only 8% of patients were found to achieve guideline levels in all parameters.For the rest, GPs adopted some of the recommendations in 55% of cases.In a sub study measuring physician adherence to guidelines for secondary prevention of dyslipidemia we found out that physicians adherence with screening and monitoring of dyslipidemia was only 43.9% and very poor with pharmacotherapy 15%.However, physicians tended to take alternative actions in most of 75%cases.Conclusions: The 4C-N intervention detected all high risk patients within 18 months and increase physician awareness.However, results are raising a question about the appropriateness of measuring clinical work by orthodox guideline adherence.