Several important cohort studies over the past decade have shed considerable light on the risk factors for the development of CHD. In most of these studies, however, black women were either not included as study subjects or the results of studies were not stratified to specifically examine racial differences. The under representation of black women in large scale cohort studies in the United States that have focused on cardiac factors may prove to be an important omission. The consistent reporting of higher prevalence of risk factors in African American women and the cumulative effect of co-morbity coupled with a disadvantageous socioeconomic profile may eventually prove that the magnitude of disease in this cohort has been significantly understudied and hence under reported. Given the emergence of intriguing racial/gender comparison disparities, insights in to the complex interplay of biological and environmental determinants of CHD in African American Women may prove very helpful in promoting our understanding of heart disease.