Despite the progress made in the past quarter century in decreasing the incidence of CHD, it remains the major cause of death for both men and women in the U.S. and in other industrialized societies. A nationally coordinated public policy effort that combines community programs, focusing on healthy lifestyles and screening for risk factors, with medical screening and treatment of patients at increased risk would expand current efforts. The power of major health promotion organizations and opinion leaders to foster population changes in CVD risk should not be underestimated. In the absence of a nationally coordinated program, increased integration of local efforts that encourage and reward healthy behaviors, screen for CV risk factors, and refer individuals to medical practices or hospital clinics for treatment and surveillance will best advance the cause of CVD prevention. Consolidation of resources, integrating the support of government, health promotion organizations, and private industry to use the media effectively to educate and encourage lifestyle change will be a major challenge. The role of government may need to be better defined, both in terms of how it might coordinate and fund the overall prevention effort on a national scale and how it might expand its role in supporting healthy lifestyles at the local level.