This review summarizes current knowledge about differences in cardiovascular disease and its risk factors among minorities in the US population. The limited information available about differences in the association of obesity with cardiovascular disease risk factors in minorities is described. Our thesis is that environment and its evolutionary influence are important in risk-factor changes, although genetic characteristics moderate the impact of these factors. This review attempts to illustrate how studies of minority groups can help us to understand the importance and interaction of factors leading to increased cardiovascular disease risk. We suggest guidelines for the design of studies that will help us to better explain differences in cardiovascular disease and its risk factors among minorities and to improve therapy for this common disorder. Because diabetes is a major topic of the First International Conference on Race, Ethnicity, and Health, data on this disease are used in many of the examples presented.