As a major risk factor for coronary heart disease, hypercholesterolemia is responsible for a significant number of illnesses and deaths, and contributes considerably to health care costs. Lowering cholesterol levels reduces the risk of coronary heart disease and may halt or reverse atherosclerosis. Lifestyle modifications include dietary measures and aerobic exercise. Pharmacologic therapy can further decrease cholesterol levels. Family physicians need to recognize patients at risk for hypercholesterolemia (and thus coronary heart disease), institute appropriate therapy and counsel family members about disease prevention.