Abstract Body: IntroductionCoronary atherosclerotic disease (CAD) carries the highest risk of recurrent stroke, up to 15% annually, and individuals with coronary heart disease are twice as likely to have a stroke. This study aims to analyze annual mortality trends and sociodemographic factors related to stroke in CAD patients in the U.S. and Texas from 1999 to 2020, to inform public health policies MethodsUsing the CDC's WONDER database from 1999 to 2020, focusing on stroke and CAD-related mortality(ICD-10 code I64.0 “Stroke” & Code I25.1 “Atherosclerotic heart disease ”) in adults aged ≥45 years, annual percent changes(APCs) in age-adjusted mortality rates (AAMRs) with 95% confidence intervals across various demographic (sex, race/ethnicity, age) subgroups were calculated.ResultsThe AAMR for stroke-related mortality in CAD cases reduced in the US from an adjusted rate(AR) 174.5 in 1999 to 105.2 in 2009(APC: 5.48%; 95% CI: -6.09% to -5.24%) after which it reduced further to 69.4 in 2018(APC: -7.87%; 95% CI: -8.77% to -6.53%) then it increased to 75.9 in 2020(APC: 4.38%; 95% CI: 2.63% to 5.88%). In Texas, AAMR for stroke-associated CAD-related mortality overall decreased from AR 189.7 in 1999 to 73.5 in 2020(APC: -4.96%; 95% CI: -5.27% to -4.66%). Males had higher consistently higher AAMRs than females (83 vs. 69.5). The AAMR in the US men decreased from 183.7 in 1999 to 72.9 in 2018(APC: -7.23%; 95% CI: -8.22% to -5.92%), then it increased to 83 in 2020(APC: 6.40%; 95% CI: 4.31% to 8.19%). The AAMR in the US women decreased from 166.3 in 1999 to 65.7 in 2018(APC: -7.89%; 95% CI: -8.79% to -6.63%) after which it increased to 69.5 in 2020(APC: 2.38%; 95% CI: 0.49% to 4.06 %). The non-Hispanic (NH) Black or African American (AA) has the greatest AAMR (122), followed by the NH American Indian or Alaska Native with an AAMR (76.8) and the NH White population with an AAMR (72.9). The low-risk populations were the Hispanic or Latino (58.8) and the NH Asian or Pacific Islander (54.2). AAMR also varied by region (overall AAMR: Midwest: 82.1; South:82; Northeast:67.1; West:66.4) & non-metropolitan areas had higher AAMR (non-core areas:98.5; micropolitan areas:94) than metropolitan areas (large fringe areas:69.3; large central metropolitan areas:66.7).ConclusionsThe stroke-related mortality in CAD cases has overall risen in the US compared to Texas over the past two decades, specifically men and (NH) Black or AA, (NH) American Indian or Alaska Native and (NH) White are at high risk.