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Given the ARIC finding that CHD is particularly prevalent in African American women under the age of 54, it is possible that the mechanisms of CHD as well as the relative roles of risk factors are different in African American women. Clearly, exploration in to the potentially unique biological explanation of CHD in African women is warranted and possibly long overdue. Much research is also needed in to the complex relationship between behavior and prevention of CHD in African Americans, especially African American women. Although reduction in risk factors has been shown to be an effective prevention strategy for the general population, studies that outline the efficacy of prevention strategies in African Americans are minimal. To date, results of large scale studies that included either whites or men only tend to be generalized to African American women. Given the biological and cultural differences that have to date been identified in this group, research in to culturally validated instruments for data collection as well as health-care seeking behaviors are priority areas. In view of the fact the high incidence of CHD in African American women is highly related to the prevalence and co-morbidity of traditional risk factors, this group is quite likely to derive substantial benefit from well designed prevention strategies.