Annual mortality rates for cardiovascular disease in the U.S. have declined steadily since at least 1968, with an accelerated rate of decline since approximately 1972. Although these trends have been seen in both men and women and in both Blacks and Whites, there have been relative differences in the rate of decline by region and state within the U.S. The relative importance of improved prevention vs. treatment in accounting for this decline has been discussed at length but not resolved, and efforts to gather relevant data are still being undertaken. Nonetheless, important changes have occurred in dietary habits with, for example, lower animal and higher vegetable fat consumption; in cigarette smoking rates, with especially important declines in middle-aged men; and in high blood pressure control, with improved levels in both genders and especially in Blacks, who have the highest rates.