Aims To determine the extent to which increases in the uptake of effective treatments could further reduce coronary heart disease mortality in Scotland. Methods and Results A cohort-based mortality model combining effectiveness data from published meta-analyses with available information on uptake of all coronary heart disease treatments in all patient categories in Scotland (population 5·1 million). In 1994, medical and surgical coronary disease treatments prevented or postponed an estimated 2722 deaths (minimum estimate 1373, maximum estimate 5986). Increasing treatment uptake to 100% of all eligible patients was considered unrealistic. Increasing uptake to 80% would have prevented or postponed a further 4078 deaths (39% from increases in secondary prevention therapies, 29%, 13%, 10% and 9% from the treatments of heart failure, acute myocardial infarction, hypertension and angina respectively). Conclusions Many eligible patients are currently not receiving treatment that is effective in reducing coronary heart disease mortality. Increasing treatment uptake could prevent or postpone a further 4080 deaths each year in Scotland, approximately, more than doubling the present benefit from treatment. By implication, about 30000 additional deaths could be prevented, annually, in the U.K. Comparable symptom and morbidity benefits might also be expected. Future clinical audit activities should focus particularly on secondary prevention and heart failure treatments.