The Evans County Heart Study was initiated to compare the epidemiology of coronary heart disease (CHD) of black and white residents of a southeastern United States community. The study was prompted by a clinical observation that CHD appeared to be less frequent in black than white patients, despite a much higher prevalence and greater severity of hypertension in blacks. A total community-based, closed cohort study was initiated with a prevalence survey in 1960-1962. The 20-year follow-up experience of the Evans County cohort confirmed the importance of the major risk factors of serum cholesterol, smoking and blood pressure for middle age and older, black and white men and women for CHD, cardiovascular disease (CVD) and all-cause mortality. Black men were less likely to die of CHD than white men, and this relative protectiveness increased upon adjusting for risk factors and also increased with age. The relative protectiveness of black men for CHD mortality was also reflected in lower black than white CVD and all-cause mortality in men 65 years of age and older.