The Old Order Mennonites are members of rural farming communities whose religious and cultural traditions pervade their dietary and health practices. These cloistered Christian communities often present special challenges to primary care physicians unfamiliar with the Mennonite way of life. Anecdotal descriptions of Mennonite customs suggest heightened risk for cardiovascular disease because of a dairy and meat-based diet and a lack of utilization of the traditional health care system.With approval from the church bishop, households from a New York State Mennonite community were interviewed about personal and family history of cardiovascular disease, knowledge of dietary cardiovascular risk factors, and personal awareness of their cardiovascular risk factor status. A standardized Saturated Fat/Cholesterol Avoidance Scale was used to assess qualitatively the community's traditional diet. Blood pressures and total serum cholesterol levels were measured in all willing participants.Two hundred fifty interviews were completed. A significant difference was found between the cholesterol level of the men (181 mg/dL) and the women (192 mg/dL). When compared with the general population, the Mennonite men had significantly lower total serum cholesterol levels and systolic and diastolic blood pressures. Only 8 percent of the study population had been previously screened for serum cholesterol. One-third of the population older than 55 years had a personal history of either myocardial infarction or stroke. The study population's score on the Saturated Fat/Cholesterol Avoidance Scale indicated a diet higher in saturated fat and cholesterol than that of other study populations.Our findings indicate a significant lack of preventive health care practices, minimal avoidance of dietary cardiovascular risk factors, and a significant difference between men's and women's cardiovascular risk factor status in this Old Order Mennonite population.