The physician-directed case management system employed in this project utilizes a management algorithm for lowering LDL-C cholesterol to the goal of less than 70 mg%. Stepwise increases in simvastatin dose to a maximum of 80 mg/day are used. Surveillance of symptoms and laboratory data to detect adverse side effects of the intervention precedes each increase in simvastatin dose. The CRNP will implement the management algorithm and concentrate on subject adherence, which is judged to be an important element in promoting compliance. The CRNP will initiate contact with the subject whenever a decision point is reached in the treatment algorithm, a deviation from the management algorithm occurs or an adverse reaction is detected. The case management model has been shown to be effective in achieving treatment goals in conditions such as hypercholesterolemia and diabetes mellitus.