The Coronary Artery Risk Development in Young Adults (CARDIA) study was established in 1985 by the National Heart, Lung, and Blood Institute (NHLBI) to study the distribution and evolution of cardiovascular disease risk beginning in young adulthood in four U.S. communities (Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA) (http://www.cardia.dopm.uab.edu/). The original cohort (n=5,115) was selected to have approximately the same number of participants in subgroups of age (18-24 and 25-30), sex, race (black and white), and education (high school or less and more than high school) within each community. At Year 30, the eighth examination, participants will be 48-60 years old, a time when risk factors and subclinical abnormalities are prevalent and clinical events continue to emerge. CARDIA offers the opportunity to address aspects of the development and progression of subclinical and clinical disease that cannot be addressed in older cohorts. Specifically, CARDIA offers the opportunity to phenotype early cardiovascular disease, including heart failure in a large cohort of white and black adults. In addition, risk factors for cardiovascular disease can be updated. With risk factor data from previous examinations, CARDIA has the ability to study how the entire trajectory of early adulthood to mid-to-late middle-age risk factors and their control affects development and progression of cardiac dysfunction.