Abstract Relationships of parental (familial) history of coronary heart disease, stroke, hypertension, and diabetes to major coronary heart disease (CHD) risk factors were examined in 738 adults (average age, 40 years) in the Cincinnati Lipid Research Clinics Princeton School study. Men reporting parental CHD had higher plasma triglyceride and higher systolic and diastolic blood pressure than comparison group men reporting no parental CHD, stroke, hypertension, or diabetes. Women reporting parental CHD had higher plasma triglycerides than comparison group women reporting no parental CHD, stroke, hypertension, or diabetes. Men reporting stroke in one parent had higher total plasma cholesterol and triglyceride levels than comparison men. Women reporting stroke in one parent had higher triglyceride levels than comparison group women. Women reporting hypertension in one parent had higher mean triglyceride and systolic blood pressure than comparison women. Men and women reporting diabetes in one parent had higher triglyceride than comparison adults. Matching men whose fathers had died of CHD with those whose fathers were free of CHD revealed significant increments in triglyceride levels, systolic, and diastolic blood pressure in the men with positive family history of CHD. Matching women whose fathers had died of CHD with those whose fathers were free of CHD revealed higher total plasma cholesterol, low-density lipoprotein cholesterol, and Quetelet index. In men, categorical assessment by CHD risk factor levels (low, intermediate, high), revealed that plasma triglycerides and systolic blood pressure were positively associated with a parental history of CHD, while high-density lipoprotein cholesterol was inversely related. In women, similar observations were made for triglycerides. Family history is a practical tool for identification of risk to CHD, hypertension, stroke, and diabetes. Serial risk factor measurements in offspring from CHD-, hypertension-, stroke-, and diabetes-positive families should have considerable utility in early recognition and documentation of CHD risk factor levels which, in turn, should facilitate primary intervention designed to ameliorate or prevent the development of CHD.