Background and Objectives: Low-density lipoprotein cholesterol (LDL-C) reduction is critical for cardiovascular disease (CVD) prevention. This study aimed to assess the proportion of patients achieving the LDL-C target in Lithuania and to identify factors associated with target achievement. Materials and Methods: This retrospective study used anonymized health data from the Electronic Health Services and Cooperation Infrastructure Information System (ESPBI IS) in Lithuania. Adults aged ≥40 years with at least one LDL-C measurement in 2023 and no documented cancer diagnosis were included. The primary outcome was the proportion of patients achieving LDL-C < 1.8 mmol/L, the target recommended by the European Society of Cardiology guidelines for high-risk individuals. Univariate logistic regression analysis was conducted to identify factors associated with achieving the LDL-C target. Results: The study included 396,835 patients (mean age, 66.9 years). The mean LDL-C concentration was 3.32 mmol/L, and only 8.1% of patients achieved LDL-C < 1.8 mmol/L. Target achievement was higher among patients in the secondary CVD prevention group compared to primary prevention (20.6% vs. 7.3%). Over half of patients (56.4%) received no lipid-lowering therapy (LLT). Statin monotherapy was the most prescribed LLT (31.3%), while only 2.7% of patients received statin and ezetimibe combination. In logistic regression analysis, secondary prevention status, more frequent cardiologist consultations, and higher LLT prescription frequency were associated with LDL-C target achievement. Compared to patients not receiving LLT, the odds of achieving LDL-C < 1.8 mmol/L were significantly higher in those receiving statin monotherapy (odds ratio [OR]: 3.153, 95% confidence interval [CI]: 3.069–3.240), statin and ezetimibe (OR: 7.631, 95% CI: 7.267–8.013), or statin and antihypertensive (OR: 3.945, 95% CI: 3.803–4.092). Conclusions: LDL-C target attainment remains low in Lithuania, with the underuse of LLT. Broader implementation of guideline-recommended lipid-lowering strategies is needed to improve LDL-C control.