The objective was to describe trends in cardiovascular risk factors between 1980-1982 and 1995-1997 in metropolitan Minneapolis-St. Paul, Minnesota. Four population-based surveys of 4,000-6,000 adults aged 25-74 years were conducted in 1980-1982, 1985-1987, 1990-1992, and 1995-1997 using consistent sampling strategies and protocols. The authors completed interviews and examinations to characterize cardiovascular risk factors. Blood samples were drawn and assayed for several analytes including total cholesterol. Although total cholesterol decreased 7-9 mg/dl during the 1980s, no further reduction was noted between 1990-1992 and 1995-1997. Hypercholesterolemia prevalence (total cholesterol of >240 mg/dl and/or use of lipid-lowering medication) fell between 1980-1982 and 1990-1992 but increased thereafter. Current cigarette smoking, systolic blood pressure, and hypertension prevalence decreased significantly between 1980-1982 and 1995-1997. Body mass index increased substantially across the four surveys. Although there was little change in the mean leisure-time physical activity, the proportion of the population not engaging in regular exercise increased between 1990-1992 and 1995-1997. Dietary fat decreased consistently from 1980-1982 to 1995-1997, while overall caloric intake rose 8% in women but not men. To conclude, the favorable trends in hypertension, cigarette smoking, and dietary fat consumption observed in Minneapolis-St. Paul from 1980-1982 to 1995-1997 were paralleled by less favorable recent trends in total cholesterol, hypercholesterolemia, adiposity, and physical activity.