© 2016 American Journal of Preventive Medicine Introduction This study examines the health lifestyles of a cohort of blacks and whites in relation to cardiovascular disease (CVD). The link between health lifestyles and CVD is well established, but most of the focus has been on SES and more research is needed on racial differences. Methods Data were from the Coronary Artery Risk Development in Young Adults study of black (n=2,451) and white (n=2,351) men and women. Data were analyzed from baseline examinations in 1985–1986 when the participants were aged 18–30 years and any fatal or nonfatal CVD event that occurred over approximately the next 28 years (until August 2013). The first stage of the analysis used latent class models to identify distinct health lifestyles on the basis of race. The second stage used multinomial logit regression models to analyze specific characteristics in relation to the health lifestyles classes, followed by the third stage in which Cox proportional hazards models analyzed associations of the lifestyle classes with CVD risk. Results Four separate health lifestyle patterns for blacks and four for whites were identified, with the “unhealthy” lifestyle among blacks (hazard ratio, 1.60) and “most unhealthy” lifestyle among whites (hazard ratio, 3.12) showing an elevated risk of CVD. An important difference is that, in every lifestyle class, blacks showed a higher probability of excessive energy intake than whites—indicative of the potential for obesity. Conclusions Health lifestyles differ by race and support the exploratory hypothesis that distinct classes of healthy–unhealthy lifestyles exist within each racial group.