In this paper we examine the relationship between risk factors and angiographically determined coronary artery disease for blacks and whites enrolled in the Coronary Artery Surgery Study (CASS). Analysis of data from the CASS registry indicated that blacks had a higher incidence of hypertension and current cigarette smoking than did whites in CASS and that chest pain was the major reason that both blacks and whites underwent coronary angiography for suspected or proven coronary disease. The CASS data also showed that, despite high levels of risk factors and chest pain, blacks had minimal or absent coronary disease. The results of this study raise several questions. First, to what extent are blacks in CASS representative of blacks in the general population and blacks undergoing coronary angiography? Additionally, are risk factors for coronary artery disease different for blacks than for whites? And finally, how does the physician effectively treat the black patient with high levels of risk factors and minimal coronary disease?