Despite Minnesota's good standing in national health rankings, preventable heart attacks and strokes continue to be a major medical, social, and economic burden. The recent downward trend in deaths from cardiovascular diseases (CVD) is now becoming less steep, and there has been an actual increase in stroke deaths. Moreover, average risk factor levels in the population are no longer decreasing, and health behaviors are deteriorating, particularly among youth and lower socioeconomic groups. This article reviews these Minnesota trends and outlines tested and promising medical and population wide approaches for reducing further the impact of CVD and for promoting health. These include self-help, school, work site, health provider, and community-based efforts.