Purpose: PAD is associated with high cardiovascular risk, and recent guidelines recommend substantially lower LDL-C, requiring treatment escalation beyond routine statin prescribing. Vascular practice commonly relies on indicators such as statin use, which may not reflect adequate LDL-C control. Lipid control is influenced by multiple interacting factors, including treatment intensity, patient factors, and system-level constraints. As a result, patients with similar lipid levels may differ substantially in their required level of intervention. This study aimed to identify lipid management patterns in the TEAM-PAD RCT, determining associations with recognisable patient characteristics. Methodology: The TEAM-PAD RCT allocated patients with PAD to MDT or routine vascular care. We analysed lipid profiles at baseline and 9-months and performed hierarchical cluster analysis using LDL-C target achievement, number of lipid-lowering therapy (LLT) agents, and high-intensity statin use at 9-months in 123 patients with complete data. Clusters were described using clinical and demographic characteristics, with before and after comparison. Results: At 9-months, 62 patients (50.4%) had not achieved LDL-C targets, occurring in two distinct clusters. The first had limited treatment (n=34). None were on high-intensity statins, with 41% on no LLT. The second had residual poor-control despite high-intensity statins (n=28) but 79% were on statin monotherapy. Overall, 45 of 62 patients not at target were on a statin (73%). Persistent non-control was not identifiable by PAD severity (p=0.868), prior vascular procedures (p=0.125), or MDT allocation (p=0.718). Of 63 patients not at target at baseline, only 14 (22%) achieved target by 9 months. Conclusion: Poor lipid control occurred in two distinct patterns of undertreatment and inadequate treatment escalation. Achieving contemporary LDL-C targets in PAD will require practice changes to actively optimise therapy beyond statin prescription.