Purpose Elevated cholesterol is a key risk factor for Peripheral Artery Disease (PAD). All patients with PAD should be prescribed statin therapy if tolerated as cardiovascular risks can be significantly reduced lowering low-density-lipoprotein (LDL) levels to <1.8mmol/l. This cohort study aimed to evaluate utilisation and efficacy of statin prescribing in patients with PAD. Methods Patients with an established history of PAD were recruited to the TEAM-PAD randomized controlled trial which aims to improve secondary cardiovascular risk prevention through multidisciplinary care, conducted at a tertiary Sydney Hospital. Prospective baseline health data, including statin prescription, total cholesterol, and LDL levels, were analysed to describe cholesterol management. Actual LDL levels were compared to clinical guideline target recommendations for this high-risk population, accounting for pre-existing prescribed statin therapy, and projected improvements in secondary risk prevention calculated. Results Of the 80 enrolled participants, 67 had cholesterol results available and were included in this analysis. Statins were not prescribed in 13 (19%) and 67 (62.7%) were not achieving guideline-based LDL target ranges. Of the patients prescribed statins, 29 (53.7%) were not receiving an adequate dose to achieve guideline recommended LDL levels. Using a prescribing nomogram, the average dose increase required to achieve target LDL control was an incremental increase of 1.6 (±0.67) to the next highest dose of their currently prescribed statin. Conclusion Our results indicate widespread poor utilisation of statins, and inadequate calibration of optimal therapeutic dosages by surgeons managing PAD. Nurse-led prescribing, based on treatment nomograms, has potential to align treatment with guideline-directed management and significantly impact clinical practice and patient prognoses.