Purpose Effective LDL-C reduction is key to secondary prevention in atherosclerotic vascular disease. Elevated LDL-C is strongly associated with stroke and major adverse cardiac and limb events. Past guidelines recommend an LDL-C target <1.8 mmol/L; post the FOURIER-PAD trial a more aggressive level of <1.4 mmol/L is targeted. However, compliance with lipid-lowering therapy remains suboptimal in vascular populations. Methodology We conducted a four-week snapshot audit in 2024 at a single-centre vascular surgery unit, evaluating outpatient and inpatient populations. Data were retrospectively collected to assess lipid profile availability, statin intensity, use of adjunctive agents (ezetimibe, PCSK9 inhibitors), and compliance with guideline-based therapy. Results: Of 647 outpatients (165 women), only 116 (18%) had a recorded LDL-C level within the past six months; of these, 83 (72%) above the 1.8 mmol/L target. High-dose statin therapy was prescribed in 143 patients (22%), and ezetimibe in 56 (9%). Only one patient was on a PCSK9 inhibitor. Full guideline compliance was achieved in 33 patients (5%). Among 46 inpatients (18 women), 20 (43%) had a recent LDL-C value; 8 (40%) were above 1.8 mmol/L. High-intensity statin therapy was more prevalent (59%), and 18 patients were discharged with escalated therapy. Overall, 30 inpatients (65%) were considered appropriately treated during admission, either meeting LDL-C targets or having treatment optimised. Conclusions: Our audit highlights a significant shortfall in lipid monitoring and therapeutic optimisation in vascular patients, particularly in outpatient settings. Despite high cardiovascular risk, a minority received high-intensity statins or combination therapy. Inpatient care found greater compliance, likely due to intervention while admitted. These results underscore the need for systematic strategies, including routine testing and protocolised escalation, to close the gap in dyslipidaemia management in vascular populations.