Heart disease and stroke remain the first and third leading killers of all Americans, with a disproportionate share of the burden borne by African Americans. Cardiovascular and total mortality are known to be higher among African Americans than among white Americans, but reasons for these differences remain unknown. In addition, well-documented declines in CVD and coronary disease mortality in the past three decades have not been shared equally between blacks and whites. Age-adjusted death rates were identical in both groups in 1980, but by 1994 the rate among African Americans was 14% higher than in whites. The race difference in magnitude of coronary heart disease (CHD) mortality is greater in women than men and higher in middle age, such that CHD deaths tend to occur in blacks about 5 years earlier than in whites. Excess cerebrovascular disease incidence and mortality in blacks are even greater than the differences noted in CHD.