States With Highest and Lowest Cardiovascular Disease-Related Mortality in the United States (1999-2019): Top and Bottom 3.

BACKGROUND: Despite declines since the 1960s, cardiovascular diseases (CVDs) remain the leading cause of mortality in the United States. However, recent data indicate stabilization or increases in certain regions, highlighting persistent disparities. This study analyzes trends in states with the highest and lowest CVD-related age-adjusted mortality rates (AAMRs) from 1999 to 2019. METHODS: Using CDC WONDER, we conducted a retrospective analysis of CVD-related mortality in adults aged ≥ 25 years. AAMRs were calculated using ICD-10 codes I00-I99, and trends were assessed using Joinpoint regression for annual percent change (APC) and average annual percent change (AAPC). RESULTS: Between 1999 and 2019, national AAMR declined from 798.47 to 595.56 per 100 000 (AAPC: -1.5%, 95% CI: -1.8% to -1.2%). Mississippi had the highest AAMR (902.23) with the slowest decline, whereas Arizona had the lowest (530.40) with a steeper reduction. Males (702.15), non-Hispanic Black individuals (850.32), and nonmetropolitan populations (645.21) had persistently higher mortality. Urban-rural disparities widened over time. CONCLUSION: State-level variations in CVD mortality reflect persistent socioeconomic, behavioral, and healthcare disparities. These findings highlight widening regional gaps and emphasize the need for stronger, state-specific public health strategies, improved access to preventive care, and targeted interventions for disproportionately affected groups. Strengthening surveillance systems, expanding evidence-based cardiovascular prevention programs, and addressing structural determinants of health will be essential to reduce the observed disparities and sustain long-term progress in CVD mortality reduction across the United States.