After the initial three years the Strong Heart Study was renewed to: extend surveillance of the community for mortality; and to reexamine the cohort after an approximate four year interval to assess the development of cardiovascular disease and change in CVD risk factors. Echocardiography and pulmonary function testing were added to the examination protocol for the second examination. In 1996 the study was funded to continue the follow-up for morbidity and mortality and to complete a third examination of the study cohort. New measures added to the third exam included measures of carotid atherosclerosis, arterial stiffness, a substudy of asthma, and a family study pilot. The third examination of the cohort was completed in August, 1999 with 3,200 members reexamined. In addition, more than 560 participants were included in the substudy of asthma. There have been approximately 1,000 deaths among cohort members in the 12 years since the initial examination.