Large declines have occurred in cardiovascular disease mortality in both sexes in Canada during the past two decades. However, there are many countries with substantially lower rates at the present time. Ischemic heart disease mortality accounts for about 60% of cardiovascular disease mortality. Cardiovascular disease rates have declined progressively since the mid-1960s in males 35 to 64 and 65 or more years of age, as well as in females in the latter age group. In younger females, 35 to 64 years of age, a slowly progressive reduction in rates started as early as 1930. Trends for stroke mortality also reveal similar long term reductions in rates since 1930 in both sexes. Relative risks for smoking, hypertension, elevated serum cholesterol and diabetes were analyzed. Almost one-third of the cardiovascular deaths in males were attributable to smoking. Population attributable risks for the four risk factors together were 53% for both sexes. Attention is drawn to the increased risks for persons in lower socioeconomic groups and those with low standards of education and the importance of recognition of these factors in intervention programs.