Objectives: To determine population lipid profiles, awareness of hyperlipidaemia and adherence to Australian lipid management guidelines.

Design and setting: Population survey in rural south‐eastern Australia, 2004–2006.

Participants: Stratified random sample from the electoral roll. Data from 1274 participants (40%) aged 25–74 years were analysed.

Main outcome measures: Population mean total, low‐density lipoprotein and high‐density lipoprotein cholesterol (TC, LDL‐C and HDL‐C) and triglyceride (TG) concentrations, prevalence of dyslipidaemia, and treatment according to 2001 and 2005 Australian guideline target levels.

Results: Population‐adjusted mean TC, TG, LDL‐C and HDL‐C concentrations were 5.38 mmol/L (95% CI, 5.30–5.45), 1.50 mmol/L (95% CI, 1.43–1.56), 3.23 mmol/L (95% CI, 3.16–3.30) and 1.46 mmol/L (95% CI, 1.44–1.49), respectively. Prevalence of hypercholesterolaemia (TC > 5.5 mmol/L or on treatment) was 48%. Lipid‐lowering medication use was reported by 12%. Seventy‐seven of 183 participants with established cardiovascular disease (CVD) or diabetes were untreated, and of the 106 treated, 59% reached the target LDL‐C. Of those without CVD or diabetes already treated, 38% reached target LDL‐C, and 397 participants at high absolute risk did not receive primary prevention. Ninety‐five per cent of treated individuals with CVD or diabetes and 86% of others treated had cholesterol measured in the previous year. Sixty‐nine per cent of individuals at low risk aged over 45 years had their cholesterol measured within the previous 5 years.

Conclusions: A comprehensive national strategy for lowering mean population cholesterol is required, as is better implementation of absolute risk management guidelines — particularly in rural populations.