There is a consensus on the importance of lowering blood cholesterol in individuals and populations. To determine trends in the detection and treatment of elevated cholesterol, a series of studies known as the Minnesota Heart Survey evaluated cardiovascular disease, risk, and health behavior among adults in the upper Midwest between 1980 and 1992. Over 25,000 adult residents of large and small communities were surveyed for information on risk factors and health habits, including status of cholesterol detection and treatment. During those years, population levels of blood cholesterol declined significantly for both men and women, largely as the result of changes in diet. Levels of clinical detection of hypercholesterolemia, initially low, also rose. However, subjects who had been informed that they had increased lipids reported that recommendations from their physicians for dietary therapy declined, while recommendations for weight loss increased during the survey period. Medication use for elevated blood cholesterol, always low, rose slightly, but many subjects discontinued medications due to side effects, the perception that their cholesterol was controlled, lack of perceived benefit, or cost. A total of 274 primary care physicians were also surveyed. Physicians reported that they screen more frequently than in the past and initiate drug therapy at a lower threshold. Despite improving trends in detection, treatment, and follow-up for elevated blood cholesterol in the general population, >50% of U.S. citizens are still unaware of their elevated cholesterol levels and a growing segment of the population that has been identified as having elevated blood cholesterol remains untreated. Dietary therapy needs to be better utilized. Physicians also need to educate their patients about the importance of maintaining desirable cholesterol levels and to encourage compliance with medications for those who require them.