Background: Patients who are informed of their cholesterol status have been shown to take steps subsequently to reduce their risks for coronary heart disease. Accordingly, as part of a population-based strategy to reduce disease burden due to high cholesterol, the National Cholesterol Education Program (NCEP) recommends that physicians tell all patients their cholesterol test results in a clear, understandable manner and encourage all patients, regardless of their risk factor status, to reduce their fat intake. Objectives: Our objective was to assess compliance with these NCEP recommendations at a 432-bed, Midwestern, university-affiliated VA Medical Center. Methods: We surveyed, within a year of their cholesterol measurement, 250 randomly selected men and women who had bad their cholesterol checked by physician order between January 1993 and 1994. Survey results were validated against laboratory data. Results: Approximately one third of the men and women said their cholesterol had not been checked, and about one half said they had not been told their test results. Only 59% knew their cholesterol status, and only 19% accurately recalled their cholesterol number. More than half did not remember receiving dietary advice. Female gender and more years of education were correlated with cholesterol awareness on both bivariable and multivariable analyses (adjusted odds ratio [OR] = 2.00, 95% confidence intervals [CI] = 1.10, 3.67 and OR = 2.62, 95% CI = 1.43, 4.78, respectively). Respondents were more likely to accurately recall their cholesterol number if they remembered being told their test results or remembered receiving dietary advice (OR = 7.70, 95% CI = 2.04, 29.0 and OR = 2.65, 95% CI = 1.15, 6.07, respectively). Conclusions: We conclude that compliance with the NCEP population-based guidelines is poor. Physicians should endeavor to improve patients' awareness of their cholesterol status and be more diligent in prescribing dietary therapy. Medical Subject Headings (MeSH): cholesterol, screening, physician's practice patterns, recall, compliance.