Since 1968, there has been a dramatic, unprecedented decline in mortality from cardiovascular disease in the United States, especially from coronary heart disease and stroke. The decline has now been confirmed as real and has been observed in all age, sex, and race groups. Possible causes of the decline in coronary heart disease mortality include the development of the concept of acute coronary care, new drugs, sophisticated surgical techniques such as coronary artery bypass, noninvasive diagnostic methods for earlier disease detection, and the identification of specific cardiovascular risk factors. The decline has been temporally related to risk factor awareness and modification (cigarette smoking cessation, hypertension control, diet change and reduction in cholesterol). Thus, both primary prevention through lifestyle changes and improved treatment regimes have played a role in the decline.