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The endangered population of beluga whales, Delphinapterus leucas, found year-round in the waters of Cook Inlet, Alaska, is exposed to a variety of natural and anthropogenic processes that, alone or combined, could compromise their conservation and recovery. Natural risks include stranding, killer whale, Orcinus orca, predation, diseases and parasites, and environmental change. Anthropogenic factors include pressure on beluga whale prey species from commercial, sport, and subsistence fishing, pollution (other than contaminants), chemical contaminants, vessel traffic, underwater noise, and habitat alteration from development and land use. This review provides a summary of current and potential factors and key gaps in existing knowledge of these factors as they relate to Cook Inlet beluga survival and recovery.