Abstract In the last 15 years (there has been a dramatic, unprecedented decrease in the mortality rate from cardiovascular disease in the United States, especially from coronary heart disease and stroke. Possible causes of the decline in the coronary heart disease mortality rate 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 decrease has been temporarily related to increased 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 regimens have played a role in the decline. Recent studies showing the benefit of cholesterol reduction emphasize the potential for even greater decreases.