Background: National cholesterol education initiatives were implemented in the middle to late 1980s. This study examines whether there were significant increases in population cholesterol knowledge and screening and hypercholesterolemia awareness and treatment from 1980 to 1992. Methods: Three population-based surveys were conducted among adults aged 25 to 74 years in 1980-1982 (N=4086), 1985-1987 (N=5735) and 1990-1992 (N=6305) in Minneapolis-St Paul, Minn, metropolitan area as part of the Minnesota Heart Survey. Personal interviews about knowledge of cholesterol level and hypercholesterolemia awareness and treatment were conducted. Total serum cholesterol was measured; hypercholesterolemia was defined as having a total cholesterol level of 6.21 mmol/L or more (≤240 mg/dL) or current use of cholesterol-lowering medications. Hypercholesterolemia awareness was defined as the belief of a participant with hypercholesterolemia that her or his total cholesterol was high. Results: Knowledge increased from 15% in 1980- 1982 to 17% in 1985-1987 to 55% in 1990-1992 (P<.001) in women; similar trends were observed for men (19%, 22%, and 47%, respectively P<.001). Hypercholesterolemia awareness doubled during the decade (women: 17%, 1980- 1982; 24%, 1985-1987; 60%, 1990-1992; P<.001; men: 25%, 30%, and 55%, respectively; P<.001). Among participants who reported physician-diagnosed hypercholesterolemia, the prevalence of current pharmacological treatment increased from 9% in 1980-1982 to 14% in 1990-1992 in women, and from 7% to 13%, respectively, in men.