Objective To describe the current situation and trends in mortality due to cardiovascular disease (CVD) in the Americas and explore their association with economic indicators.

Design and Setting This time series study analysed mortality data from 21 countries in the region of the Americas from 2000 to the latest available year.

Main Outcomes Measures Age-adjusted death rates, annual variation in death rates. Regression analysis was used to estimate the annual variation and the association between age-adjusted rates and country income.

Results Currently, CVD comprised 33.7% of all deaths in the Americas. Rates were higher in Guyana (292/100 000), Trinidad and Tobago (289/100 000) and Venezuela (246/100 000), and lower in Canada (108/100 000), Puerto Rico (121/100 000) and Chile (125/100 000). Male rates were higher than female rates in all countries. The trend analysis showed that CVD death rates in the Americas declined −19% overall (−20% among women and −18% among men). Most countries had a significant annual decline, except Guatemala, Guyana, Suriname, Paraguay and Panama. The largest annual declines were observed in Canada (−4.8%), the USA (−3.9%) and Puerto Rico (−3.6%). Minor declines were in Mexico (−0.8%) and Cuba (−1.1%). Compared with high-income countries the difference between the median of death rates in lower middle-income countries was 56.7% higher and between upper middle-income countries was 20.6% higher.

Conclusions CVD death rates have been decreasing in most countries in the Americas. Considerable disparities still remain in the current rates and trends.