An analysis by experts at Imperial College London looked at rates for men and women aged 30-64 and over-65s.
The research, in the International Journal of Epidemiology, is thought to be the first to burrow down to look at individual electoral wards.
Heart experts said targeted interventions were needed.
The study looked at data from 1982 to 2006 across the almost 8,000 wards in England.
The places with the highest death rates were areas around Manchester and Liverpool, parts of Yorkshire, around Birmingham, and deprived boroughs of London.
Some – mainly in the north – were areas that were performing poorly in the 1980s, and have been doing well since but could not keep up with the best.
Others, spread across England, were doing averagely well – but had also fallen behind.
Deaths from cardiovascular disease (CVD) have more than halved across England overall.
However the rates for men and women aged 65 or older, the decline was smaller in the most deprived communities, which has meant that the gap between the richest and poorest areas is wider.
For men in that group, CVD deaths fell nearly five times more in the best performing 1% of wards than in the worst performing 1%.
For women, there was a 10-fold variation.
Budget ‘danger’
The researchers say the findings are important because the current poor economic situation and austerity measures are likely to disproportionately affect more deprived communities.
We have to reduce major risk factors like smoking, and provide good health services that help both with prevention through high-quality GP services and with treatmentProf Majid Ezzati,, Imperial College London
And they warn that the forthcoming devolution of public health responsibilities to local authorities might also put some communities at risk.
Dr Perviz Asaria, who worked on the study, said: “If people’s jobs are less stable, they may be forced to change their diet, or drink and smoke more.
“So we need to be concerned about these issues if we are going to carry on bringing death rates down.”
She added: “As public health gets taken up by local authorities, there’s a danger that health budgets will have to compete with other services such as schools.
“It’s essential that cardiovascular screening and prevention programmes don’t get cut as a result.”
Prof Majid Ezzati, who also worked on the research, said a major aim of the study was to find out what was being done to help people in different places and what could be done differently.
He said: “We know how to reduce cardiovascular mortality: we have to reduce major risk factors like smoking, and provide good health services that help both with prevention through high-quality GP services and with treatment.
“We need to focus on putting these into practice in places that are behind.”
Mubeen Bhutta, policy manager at the British Heart Foundation, said: “The overall decline in heart disease death rates should be something to celebrate but, worryingly, that improvement has not benefited everyone equally.
“If we’re going to make a proper job of tackling England’s biggest killer, eradicating inequalities must be at the heart of the government’s new cardiovascular disease strategy.”
She added: “The communities that need help the most must not be forgotten, and targeted interventions in the poorest neighbourhoods will help address a problem which has dogged this country for decades.”
http://www.bbc.com/news/health-20179498