As cardiovascular disease continues to be the number one killer globally according to a recent World Health Organization report in 2018, multiple efforts are directed toward primary and secondary prevention of the disease to reduce its associated morbidities and mortalities. Despite significant improvement in the acute management of acute coronary syndrome (ACS) over the past decades, outcomes among various racial and ethnic groups remain heterogeneous. Such disparity stems from multiple differences, such as the burden of underlying risk factors, access to health care, and socioeconomic status. This has resulted in clear heterogeneity in disease presentation and outcomes. In the US, among patients presenting with ACS, Black patients tend to have higher prevalence of co-morbidities, including obesity, diabetes, hypertension, end-stage renal disease on dialysis, and drug abuse, as well as lower socioeconomic status. At long-term follow-up, Black population had 1.3 times higher odds of mortality, even after adjusting for patient demographics, medical conditions, and hospital characteristics. Such disparity persisted regardless of the quality of care received. Moreover, at 30-day and 1-year follow-up, a higher rate of stent thrombosis was noted in Black women as compared with White women despite similar anti-platelet regimens for both groups at discharge, and these findings persisted after adjustment for multiple baseline characteristics.