Objective:

To evaluate national trends and disparities in mortality involving coexisting ASCVD- and stroke-related conditions among U.S. adults from 1999 to 2025.

Approach:

• Study Design: Retrospective population-based study using the CDC WONDER Multiple Cause of Death database.
• Population: Included adults aged ≥25 years.
• Mortality Identification: Deaths identified when both ASCVD-related and stroke-related ICD-10 codes were documented on the same death certificate.
• Data Analysis: Age-adjusted mortality rates (AAMRs) calculated per 100,000 using the 2000 U.S. standard population.

Key Findings:

• Total of 876,383 deaths identified with an overall average AAMR of 15.01 per 100,000.
• Mortality declined from 26.82 in 1999 to 10.91 per 100,000 in 2025, with an average annual percent change (AAPC) of −3.53% (95% CI, −4.27 to −2.78; p < 0.001).
• A borderline significant increase in AAMR was observed during 2018–2021 (APC: 6.06%; 95% CI, 0.01–12.48; p = 0.050).
• Mortality burden remained higher among men, older adults, Black individuals, residents of the South, and non-metropolitan populations.
• Adults aged 25–44 years showed a significant increase in mortality after 2015.

Interpretation:

Mortality involving coexisting ASCVD- and stroke-related conditions declined substantially from 1999 to 2025, but this progress was interrupted by a borderline reversal during the pandemic period and marked by persistent disparities.

Limitations:

• Death-certificate data do not establish clinically adjudicated concurrent disease.
• Analysis restricted to adults aged ≥25 years may overlook younger populations.

Conclusion:

Findings highlight the need for stronger and more equitable prevention strategies, particularly for younger adults and high-burden populations and regions.