The purposes of this review were to analyze and evaluate the results of school-based studies that have used population-wide approaches for primary prevention of cardiovascular diseases and to assess the extent to which strategies tested to date have been effective for minority populations in the United States. The literature included in the review was restricted to studies published between 1986 and August 1999; they sampled elementary, middle, or high school students and incorporated a control or comparison group. There were no consistent effects of school-based interventions on blood pressure, lipid profiles, or measures of body mass and obesity. There was evidence that changes in knowledge and health behaviors occurred. Findings are interpreted within the context of population-wide approaches to prevention, and recommendations for future research directions are discussed.