Cardiovascular disease (CVD) in black patients involves a complex interplay of risk, geographic, socioeconomic, and cultural factors. Modifiable risk factors such as high blood pressure, diabetes, cigarette smoking, high blood cholesterol, and physical inactivity contribute to the excess CVD mortality and morbidity in blacks. Health perceptions, health care seeking behavior, and willingness to submit to long-term preventive therapies are significantly influenced by cultural and socioeconomic factors. Early detection and control of these risk factors are particularly important because blacks tend to have multiple cardiovascular risks. The importance of churches and religious organizations in the black community should be harnessed by long-term strategies of CVD prevention. Emphasis on training of minority health care professionals who are most likely to practice in medically underserved areas should involve minority health professional schools. In the final analysis, CVD prevention in blacks should focus on control of risk factors; however, the role of environmental factors should be recognized, including socioeconomic status on access to health care and prevention. Long-term strategies of CVD prevention must involve active collaboration of health care providers and researchers to develop and test effective strategies. Churches and other religious organizations are effective but underutilized partners in CVD prevention in blacks.