In a series of clinical trials and epidemiologic studies over the past 30 years, clear associations have been established between saturated fat in the diet, elevated serum cholesterol levels, and the risk of coronary heart disease (CHD). This understanding has been applied in intervention trials using diet, exercise, and drugs to lower cholesterol. The National Cholesterol Education Program was established in 1985 to coordinate efforts to make U.S. citizens aware of the risks of elevated cholesterol and to provide guidelines for lowering it. Trials over the last several years have demonstrated benefit of cholesterol lowering in secondary prevention and producing regression of coronary lesions. While much progress has been made, we are still far from the goal of eliminating hypercholesterolemia in the United States. Improved educational efforts and new strategies for cholesterol management are needed.