Cardiovascular disease is the leading cause of death in most industrialised countries and is a major source of health care expenditure worldwide. Identification and management of risk factors for the development of coronary heart disease (CHD) have enormous potential for improving health and reducing health care costs. There is evidence that the reduction in deaths from CHD has occurred earlier and to a greater extent in countries with aggressive policies of cardiovascular risk factor intervention. Likewise, the treatment of patients presenting with acute myocardial infarction (MI) should be aimed at both extending event-free survival and improving the quality of life. This review focuses on recent advances and future directions in the understanding of risk factor modification before an MI (prevention), treatment of MI including thrombolysis and primary percutaneous transluminal coronary angioplasty, and the subsequent management of patients after MI.