Coronary heart disease accounted for 489,171 deaths in 1990. Age-adjusted death rates decreased faster between 1976 and 1990 for white men than for white women or blacks. Out of hospital death rates for coronary heart disease decreased in the 1980s. Hospital fatality rates for acute myocardial infarction continued a long-term decrease through 1990. Trends in risk factors and invasive procedures support the conclusion that risk factor reduction has resulted in reduced incidence of acute myocardial infarction and sudden coronary death and that improvements in medical care have resulted in a continued decrease in acute myocardial infarction fatalities and overall coronary deaths.