Primary care physicians play a pivotal role in the successful implementation of the National Cholesterol Educational Program (NCEP) guidelines for both population and high-risk approaches to reduce blood cholesterol levels in children and adults. Increasingly, in this era of health cost containment, the primary care physician is recognized as (1) the main and sometimes the only source of health care for large numbers of individuals; (2) the affordable physician and (3) the gatekeeper for referral to medical specialists. Achievement of NCEP guidelines for cholesterol reduction, American Heart Association (AHA) guidelines for prevention of cardiovascular disease, and Year 2000 National Objectives for Health Promotion and Disease Prevention will all rely heavily on the active cooperation and support of practicing internists, pediatricians, and family/general practitioners in providing patient education, risk factor evaluation and intervention. Although the majority of primary care physicians intuitively support the concept of preventive cardiology and generally have a high level of knowledge of cardiovascular risk factors, a significant gap remains between physician knowledge and attitudes and the actual practice of preventive cardiology in clinical practice. Despite these limitations in implementation of clinical guidelines, significant progress has been made in the past decade in reaching NCEP and Year 2000 goals for population-wide cholesterol reduction.