The objective of the present work is to assess the ability of primary care physicians to apply correctly the recent hyperlipidemia management guidelines. A cross – sectional study of primary care physicians working in the family medicine department affiliated with a tertiary hospital. Using 63 patient problem vignettes, which included lipid biochemistry, and a number of cardiovascular risk factors, each physician was asked, if a patient required no treatment, dietary or drug treatment. The vignette cases were matched against the NCEP ATPII guidelines. Forty-five physicians were recruited in this study. The Kappa statistics showed only two (4.4%) had excellent agreement, nine (20%) fair to good agreement while the remaining thirty-four (75.6%) of the physicians had poor agreement. The median Kappa statistics of 0.3 and a mean of 0.33 (SD = 0.18) suggested an overall poor agreement. Overall, the decisions to treat with medications were more consistent with the NCEP guidelines than diet alone or no treatment decisions. Saudi and younger physicians had statistically significant (P < 0.05) higher Kappa statistics than older (> 35 years) and Non – Saudi physicians. About one third of the physicians were not consistent with guidelines rec-ommended by the NCEP-ATPII. The majority of the expatriate doctors are not following the NCEP which is evidence based and the most widely accepted guideline. Therefore, it is suggested that only one guideline to be adopted as a standard, and doctors must undergo adequate training and continuous evaluation of their skills.