Atherosclerotic cardiovascular disease (ASCVD) significantly contributes to morbidity and mortality in the United States. However, data on ASCVD-related mortality trends among older adults remain limited. This study aims to delineate contemporary mortality trends across various sociodemographic and regional groups in the United States. We queried the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) for ASCVD-related death data from 1999 to 2021, focusing on demographic factors (sex, race/ethnicity) and geographic regions (state, urban-rural). We calculated age-adjusted mortality rates (AAMRs) per 100,000 individuals and determined annual percentage changes (APCs) using the Joinpoint Regression Program Version 5.2.0.0. From 1999 to 2021, there were 9,307,495 ASCVD-related deaths among older adults. The AAMR declined sharply from 1,370.7 per 100,000 in 1999 to 803.5 in 2014, with an APC of -3.63%. This decline was followed by a stable period from 2014 to 2019, after which the AAMR rose from 741.3 in 2019 to 841.5 in 2021, yielding an APC of 6.99%. Overall, males exhibited a higher average AAMR (1,269.2) than females (749.8). Among racial groups, non-Hispanic (NH) White individuals had the highest AAMR (988.3), whereas NH Asian and Pacific Islander individuals had the lowest (536.7). Geographically, the Northeast showed the highest AAMR (1067.8) compared with the western region (899.2). Rural areas also displayed a significantly higher AAMR (993.5) than urban areas (954.7). Despite initial improvements in ASCVD-related mortality, recent trends indicate an increase. Notable disparities persist across demographic and regional groups, underscoring the need for further investigation.