Life expectancy and cardiovascular health have improved dramatically for Americans over the past century, with marked declines in stroke and coronary heart disease morbidity and mortality. Distribution of these benefits, however, has not occurred equitably. Racial and ethnic minorities often receive inferior healthcare, even when their income and insurance status are similar to Caucasian patients. A large portion of these disparities are related to cardiovascular disease. Efforts in research and education and improvements in cultural competence are all ultimately underway. Specific tools and programs, including novel use of electronic medical records, are emerging, and in the future, they will hopefully assist in overcoming the differences in health and disease that many Americans experience. These differences may be approached by managed care and federal and academic center initiatives. This review describes what is being done presently and what needs to be considered in the future to combat these disparities.