Heart attacks and strokes cause substantial morbidity and mortality, while implementation of cholesterol and other CV prevention guidelines remain low. Proposed NCQA on-statin in the last year among those with DM was 46% in national field testing, and about 75% in Kaiser Permanente (KP). KP has had some success overcoming barriers to statin, aspirin, and blood pressure medicine adherence. If the nation as a whole is able to improve treatment rates per guidelines, more events can be prevented with overall cost savings. Polypill, value based insurance (free meds that reduce downstream costs) and other tactics warrant research funding, promotion, and dissemination.