This paper exploits the unexpected decline in the death rate from cardiovascular diseases since the 1970s as a large positive health shock that affected predominantly old-age mortality; i.e. the fourth stage of the epidemiological transition. Using a difference-in-differences estimation strategy, we find that US states with higher mortality rates from cardiovascular disease prior to the 1970s experienced greater increases in adult life expectancy and higher education enrollment. Our estimates suggest that a one-standard deviation higher treatment intensity is associated with an increase in adult life expectancy of 0.37 years and 0.07–0.15 more years of higher education.