In order to evaluate the contribution of hypertension, diabetes, smoking and serum cholesterol on coronary heart disease mortality in Mexico, an ecologic study was developed. Mortality rates of coronary heart disease (CHD), diabetes and hypertension; the proportion of people smoking six or more cigarettes daily; and the mean serum cholesterol levels, were recorded for each of the states of Mexico. All variables were included in a multiple linear regression model, taking CHD mortality as the dependent variable. All variables explained more than two thirds of the occurrence of CHD mortality. However either using a backward or a forward method, only serum cholesterol and diabetes mortality had a significative contribution on CHD mortality (re = 0.65; F = 27; p < 0.0001). Coronary heart disease mortality in Mexico has shown an increasing trend in the last 50 years. Mexican-americans in the United States have a high prevalence of major risk factors, but few studies have done to assess its contribution in Mexicans living in Mexico. This increase may be explained by an increase in the occurrence of diabetes and the still denied importance of high serum cholesterol.