Although there have been advances in ischemic heart disease (IHD) care, variation in IHD-related mortality trends across the United States has not been well described. We used the CDC-WONDER database to evaluate variation in IHD-related mortality for demographic groups in the U.S. between 1999 and 2019. Age-adjusted mortality rates (AAMR) were stratified by sex, race, Hispanic ethnicity, and U.S. state. Crude mortality rates were evaluated using 10-year age groups. IHD-related AAMR decreased from 195 to 88 per 100,000 nationally, with slower decline from 2010-2019 (average annual percent change [AAPC] -2.6% [95% CI -2.9% to -2.2%) compared to 2002-2010 (AAPC -5.3% [95% CI -5.6% to -4.9%]). All groups had decreases in AAMR, though black populations persistently had the highest AAMR, and women had greater relative decreases than men. AAPC was -3.7% for white men; -4.7% for white women; -3.9% for black men; -4.9% for black women; -4.1% for Hispanic men, and -5.1% for Hispanic women. Populations ≥65 years old had greater relative mortality declines compared to populations <65 years. The median AAMR (2019) and AAPC (1999-2019) across states was 86.3 (range 58 – 134) and -3.8% (range -1.7% to -4.8%), respectively. In conclusion, mortality declines due to IHD have slowed in the U.S., with significant geographic variation. Black populations persistently had the highest AAMR, and declines were relatively greater for women and populations ≥65 years. The impact of demographics and geography on IHD should be further explored and addressed as part of public health measures
