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Immigrants from the former Soviet Union have a higher prevalence of cardiac risk factors and more problems obtaining health care in the United States than American-born Caucasians. This study compared differences between patients of these two populations admitted for diagnosis of chest pain or shortness of breath. Immigrants from the former Soviet Union (who had been in the U.S. for an average of 20 years) had more cardiac risk factors than American-born Caucasians including more hypertension (81% vs. 50%, p=.002), positive family history (53% vs. 30%, p=.030), more previous heart attacks (45% vs. 20%, p=.012), more prior cardiac catheterizations (51% vs. 18%, p<.001) and coronary revascularization procedures (51% vs. 27%, p=.022), and higher systolic blood pressure (138+/-13 vs. 129+/-23 mmHg, p=.019) upon presentation to the hospital. Fifty-five percent of immigrant patients used foreign medications. Thus, there are major differences between immigrants from the former Soviet Union who are admitted to the cardiac units of an urban New York hospital and American-born Caucasians. Knowledge of these differences is important for caregivers.