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Objectives. we examined racial differences in cardiac catheterization rates and reviewed whether patients' beliefs or other variables were associated with observed disparities. methods. we did a prospective observational cohort study of 1045 white and african american patients at 5 veterans affairs va ; medical centers whose nuclear imaging studies indicated reversible cardiac ischemia. results. there were few demographic differences between white and african american patients in our sample. african americans were less likely than whites to undergo cardiac catheterization. african americans were more likely than whites to indicate a strong reliance on religion and to report racial and social class discrimination and were less likely to indicate a generalized trust in people but did not differ from white patients on numerous other attitudes about health and health care. neither sociodemographic or clinical characteristics nor patients' beliefs explained the observed disparities, but physicians' assessments of the procedure's importance and patients' likelihood of coronary disease seemed to account for differences not otherwise explained. conclusions. patients' preferences are not the likely source of racial disparities in the use of cardiac catheterization among veterans using va care, but physicians' assessments warrant further attention. j public health. 2004; 94: 20912097 ; there were racial disparities in the use of c-cath in our cohort, and if so, to comprehensively examine whether patients' attitudes and beliefs or physicians' assessments and perceptions about patients could explain this racial disparity when we controlled for the effects of clinical and sociodemographic characteristics. aging studies performed between august 1999 and january 2001. we considered the nuclear imaging study results positive if there was any evidence of reversible cardiac ischemia evidenced by reversible defects or redistribution ; . patients were ineligible if they had no reversible ischemia; had received c-cath, any revascularization, or heart transplant surgery in the 6 months before their nuclear imaging study; had participated in a clinical trial that determined their cardiac treatment; were of a race that was not white or african american; were not veterans; or were unable to complete the survey because of cognitive impairment. we screened 5278 patients, and 2335 44% ; had a positive nuclear imaging study. of these, 456 patients 20% ; were excluded because we were unable to contact them to enroll in the study, 78 3% ; because they had impaired mental status, 32 1% ; because they were in another research study determining their cardiac treatment, 102 4% ; because they were not african american or white. 2nd dam traumerei ger ; : 2 wins at 2 and 4 and placed 4 times inc. 2nd saval beg s., l.; dam of 9 winners inc.: tertia ire ; f. by polish patriot usa ; ; : 3 wins at 3 and 20, 855 and placed 5 times inc. 2nd natural gas energy rated home trigo s., l.; dam of a winner: tangle ire ; : 3 wins, 176, 821 viz. winner at 2; also 2 wins at 4, 2004 in u.s.a., placed 2nd yellow ribbon s., gr.1, miesque s., gr.3, appalachian s., l., 3rd la canada s., gr.2 and palomar breeders' cup h., gr.2. vrin ire ; : 4 wins, 29, 097 inc. winner at 3 and placed. time on your side ire ; : 4 wins, 24, 352 inc. 3 wins at 3, 2004 and placed. landescent ire ; : 3 wins at 2 and 4, 2004 and placed 5 times. backcloth ire ; 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