Coronary heart disease (CHD) is the leading cause of death in African Americans. CHD mortality rates have not declined in recent years as much as they did from 1970–1990. Significant mortality rate variations exist related to regional, socioeconomic, and sociocultural factors. Risk factors detected in white populations (age, gender, hypertension, lipoprotein levels, cigarette smoking, diabetes, socioeconomic status) all are operative in African Americans. The excess prevalence of hypertension and diabetes enhances CHD risk in African Americans. Left ventricular hypertrophy is a major indicator of excess risk. African Americans are less likely than Whites to undergo cardiac catheterization, percutaneous intervention, and coronary bypass surgery, and to have risk factors detected and treated adequately. CHD mortality in African Americans is unlikely to decline further without significant changes in the awareness, attitudes, and behavior of physicians who treat African American patients.