BACKGROUND Efforts to control the continuing epidemic of coronary heart disease in the United States have been successful according to certain criteria, such as mortality, but by others, such as morbidity, the picture is less clear. Documenting whether various subgroups of the population have adopted healthier lifestyles that are likely to reduce coronary heart disease risk is essential to understanding the status of the epidemic and, most importantly, to formulating prevention and health education strategies that will ameliorate its effects. METHODS The Framingham Offspring Study cohort participated in extensive health screening protocols to determine their cardiovascular risk. The 2,846 men and women who were between the ages of 25 and 64 years and who reported their educational attainment level are the subject of this report. RESULTS Both body mass index and cigarette smoking showed inverse relationships to educational attainment among both men and women, while reported vigorous leisure time physical activity showed a positive relationship to educational attainment. However, fitness levels as assessed by treadmill duration were directly related to educational attainment only the women. With the exception of total plasma cholesterol among women, all coronary heart disease risk factors had most adverse levels in the least educated study participants. CONCLUSIONS This study indicates that most components of the coronary heart disease risk profile show adverse levels in individuals with low educational attainment.