The true significance of a family history of cardiovascular diseases (CVD) as an independent risk factor has not been sufficiently studied. Objective — to assess the relationship of a family history of CVD to the level of major risk factors for this disease in children according to the results of a long-term prospective follow-up. Subject and methods. Children whose parents suffered from CVD during life or died prematurely from this disease were selected for primary examination in 1990—1991. A total of 157 people (a risk group (Group 1) (n=50) and a comparison group (Group 2) (n=107) were followed up. Over 32 years, four surveys were conducted, which included a standard questionnaire survey, three-fold blood pressure measurements, anthropometry, determination of the serum levels of total cholesterol, high-density lipoprotein cholesterol, and triglycerides, and ECG. Carotid intima-media thickness was determined by applanation tonometry during the last survey. Results. A group of men who had a family history of CVD in their parents was ascertained to have atherogenic lipoprotein spectrum changes as an elevated apo-B level that was increased during the prospective follow-up. The overall 10-year risk of fatal CVD in middle-aged men with a family history of early coronary heart disease in their fathers was higher than in those in the control group. In both groups, total cholesterol and smoking made a decisive contribution to the overall risk of cardiovascular deaths. The risk of subclinical atherosclerosis (intima-media complex (IMC) thickening during adulthood was 6.1 times higher in men with a family history of CVD in their parents than that in their peers with no family history. Early primary prevention of CVD in people with a family history is required, which should lead to a decrease in CVD morbidity and mortality rates in adulthood.