Coronary artery disease is the leading cause of death among black women in the United States. Black women also demonstrate a greater prevalence of coronary risk factors and a higher mortality after myocardial infarction than white women. To evaluate the clinical profile and outcome of black women in an urban-based cardiac rehabilitation program, 35 black women (aged 54 +/- 13 years) and 47 white women (aged 57 +/- 10 years) were prospectively studied. Black women had similar admitting diagnoses as white women, with recent myocardial infarction being the most common (37%). Coronary risk factors were more prevalent in black women than white women in the program: hypertension (71% vs 53%; p = 0.09) diabetes mellitus (46% vs 26%; p = 0.06), obesity (74% vs 49%; p < 0.05). Cholesterol and high-density lipoprotein levels were similarly elevated in black (251 +/- 53 mg/dl) and in white (248 +/- 52 mg/dl) women, whereas 34% of black and 21% of white women were active smokers. There was no significant difference in initial exercise capacity at program entry. Fewer black women (51%) completed the 12-week program than white women (64%), p = NS. Comparison of initial and follow-up exercise tests after 12 weeks of moderate to high-intensity dynamic exercise demonstrated significant and similar improvements in functional capacity in both black (4.2 +/- 1.6 vs 5.6 +/- 1.7 METs; p < 0.001) and white (4.8 +/- 2.2 vs 5.7 +/- 2.2 METs; p < 0.01) women. Among obese patients, only the white women lost weight.(ABSTRACT TRUNCATED AT 250 WORDS)