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Background Low-density lipoprotein cholesterol is one of the prime atherogenic factors, and statins are used to reduce low-density lipoprotein cholesterol. However, concerns about misuse and adverse effects regarding statins have risen lately. This study aims to assess the statin prescription practice and the perceptions about guidelines among doctors in Tamil Nadu. Methods A cross-sectional, questionnaire-based survey of physicians practicing in Tamil Nadu was conducted from January 2024 to September 2024. Physicians who have prescribed statins in the past 3 years were included in the study through a voluntary opt-in sampling technique. The estimated sample size was 185. Required permissions and consents were obtained from the ethical committee and individual participants. Results The participants had a mean age of 31.5 years, with 62.2% having under 6 years of experience. Although 58.4% were aware of the American College of Cardiology/American Heart Association guidelines, only 5.9% agreed; for the Lipid Association of India, 18.9% were aware, with 2.7% in agreement. Over the past 6 months, 84.8% had modified their statin prescriptions. Atorvastatin was the most commonly prescribed statin. While 85.4% had encountered statin intolerance, only 12.9% were aware of the reporting system, and merely 3.2% had reported such cases, despite frequent observation of side effects, like myopathy (22.2%) and myalgia (8.6%). Conclusions The study reveals a gap in physicians’ awareness and application of statin guidelines, with low adherence, inconsistent risk assessment, and dosing practices. It recommends developing ethnicity-specific risk tools and strengthening national guidelines for consistent, evidence-based dyslipidemia management.