Background: Few data are available on the secular changes in sudden coronary heart disease (CHD) death in US communities. Methods: We examined trends in sudden CHD death from 1987 to 2004, using data from the Atherosclerosis Risk in Communities (ARIC) study. Sudden CHD deaths in residents of 4 communities aged 35 to 74 years were ascertained using multiple sources such as death certificates, informant and coroner interviews, and physician adjudications. Poisson regression was used to assess the trends for the 6 periods: 1987 to 1989, 1990 to 1992, 1993 to 1995, 1996 to 1998, 1999 to 2001, 2002 to 2004, after adjusting for demographic factors. Results: Overall, 32.6% of CHD deaths were sudden, occurring within an hour after the onset of symptoms, 63.5% of which had no prior diagnosis of CHD. For women, the rate declined by 40% (P = .059) for sudden deaths with CHD history, 27% (P = .067) for those without CHD history, and 39% (P < .001) for nonsudden CHD deaths. The trends did not differ by community. For men, the trends differed by community for sudden deaths with and without CHD history (Ps for the interaction= .019 and .009, respectively) but not for nonsudden CHD death (P for the interaction= .10). For all communities combined, the decline in men was greatest for sudden deaths with CHD history (by 58%, P < .001), followed by nonsudden CHD deaths (by 39%, P < .001) and sudden deaths without CHD history (by 31%, P = .002). However, the proportion of CHD deaths that were sudden had remained stable over time. Conclusion: Although the rate of sudden CHD deaths, with and without CHD history, declined over time, the trend pattern may differ by community and gender.