This paper examines changes in ischaemic heart disease mortality in New South Wales between 1969 and 1994, with particular reference to the 1969-1973, 1979-1983, 1985-1989 and 1990-1994 periods. Using death certificate data and unit list mortality files, and considering occupational differentials among males, and marital status and regional and intra-metropolitan variations among males and females, the question whether changes in differentials in mortality from heart disease occurred during this mortality transition is asked. Mortality from ischaemic heart disease declined in all marital status and occupational status groups, and in all geographical areas, but it declined more slowly among never married and divorced males, among manual workers, and in lower income areas. Whereas ischaemic heart disease mortality was lower in most rural areas than in metropolitan Sydney at the beginning of the period, in the 1990s it was significantly more elevated in inland small towns and rural areas than in the metropolis. Differentials increased over time, more especially with males.