Background An elevated serum lipid is one of the major risk factors for coronary heart disease (CHD). Physicians' awareness contributes to successful adoption of practice guidelines. Community medical centers are the primary defense against chronic disease. This study aimed to investigate community physicians' awareness of cholesterol guidelines and their utilization. Methods Six hundred and one community physicians were randomly selected from four different regions, and completed a confidential and semi-structured questionnaire. Four hundred and ninety-one completed the questionnaire, and 486 valid questionnaires were available. Results The physicians' fundamental knowledge of lipids was astonishingly poor, while the awareness of cholesterol guidelines was low. Only 24% and 14% of the physicians reported the right optimal low-density lipoprotein cholesterol (LDL-C) level for CHD and diabetes patients respectively. More than half of the physicians (55.8%) mistakenly considered elevated transaminases to be the lethal side effect of statins. More than half of the physicians (51.9%) would give up statin treatment in the case of transaminase elevation. Conclusion Educational interventions to improve cholesterol knowledge and to publicize standard treatment are needed among Chinese community physicians. Chin Med J 2010;123(7):884-889