Lipoprotein measurements from the Third National Health and Nutrition Education Survey were used to estimate the need to measure fasting lipid concentrations and offer dietary and drug interventions in the US population. In this review, we compare the distribution of the Third National Health and Nutrition Education Survey population (according to National Cholesterol Education Program guidelines) with a contemporary sample of lipoprotein measurements in 4549 American Indians. Compared with data from the former, relatively fewer American Indians have cholesterol levels greater than 240 mg dl-1 and a much larger proportion have 'desirable' cholesterol levels less than 200 mg dl-1. The above guidelines, dictating measurement of fasting lipoprotein concentrations and dietary or drug intervention, take into account age, presence of cardiovascular risk factors and levels of both HDL- and LDL-cholesterol. The proportion of American Indians requiring these interventions is somewhat at less than the Third National Health and Nutrition Education Survey population, even though the American Indian population in this comparison is generally older (45-74 years of age) than the Survey participants (20 to more than 75 years of age). We review the literature concerning lipoprotein measurements in other American Indian and ethnic population groups that are undergoing rapid changes in lifestyle. In general, cardiovascular risk factors, including lipoprotein concentrations, are accumulating. These factors suggest that the public health impact of coronary heart disease will increase as these populations undergo further lifestyle changes.