Background--Disparities in stroke and heart disease have been well defined in many populations in the United States. Relatively few studies, however, have assessed current disparities in cardiovascular disease in American Indian populations and compared trends with other regions of the United States.

Methods and Results--Using mortality data, age-adjusted all-cause, heart disease, and stroke mortality rates (per 100 000) were calculated for American Indians and whites from 1991 to 1995 and 1996 to 2000. The all-cause mortality rate was strikingly higher for American Indians than for whites. For example, during 1996 to 2000, the all-cause mortality rate for American Indians (1317, ±61) was more than half again greater than that for whites (831, ±8). Heart disease mortality declined significantly in whites (237 to 216 per 100 000) in Montana over the past decade and declined, although not significantly, in American Indians (326 to 283 per 100 000). Stroke mortality also declined significantly in whites (64 to 60 per 100 000) but not in American Indians (80 to 81 per 100 000) during this time period. The proportion of deaths before age 65 years for heart disease and stroke was considerably higher in Indian men (45% and 36%) and Indian women (29% and 28%) compared with white men (21% and 11%) and white women (8% and 7%).

Conclusions--The disparity in heart disease and stroke mortality exists between American Indians and whites in Montana. Regional or state-level surveillance data will be needed to describe the changing patterns of heart disease and stroke mortality and cardiovascular risk factors in many native communities in the United States and Canada.