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Objective(s): To examine racial differences in the relationship between cardiovascular (CV) risk factors measured since age 10 years and left ventricular mass index (LVMI) in adulthood in the National Heart, Lung, and Blood Institute Growth and Health Study., Study Design: Longitudinal investigation with CV risk factors measured throughout childhood and LVMI measured in adulthood. In total, 556 black and white girls were recruited from schools in the greater Cincinnati area. Analyses examined traditional CV risk factors at baseline, follow-up, and over time (ie, area under the curve [AUC]). LVMI was collected with 2-dimensional guided echocardiographic imaging at a mean age of 25.7 ± 1.7 years., Results: Black girls had higher adiposity and insulin and lower heart rate across time (all P < .05). Blacks had higher LVMI compared with whites in adulthood. Major determinants of young adult LVMI, were race, body mass index z score AUC, systolic blood pressure z score AUC, percent body fat by skin fold AUC, heart rate AUC, and an interaction between race and heart rate (model R 2  = 0.40, P < .0001)., Conclusions: The major determinants of LVMI in young female adults are race, adiposity, and systolic blood pressure., (Copyright © 2019 Elsevier Inc. All rights reserved.)