Cardiovascular diseases cause approximately one-third of all deaths in the world, of which 7.5 million deaths are estimated to be due to ischaemic heart disease (IHD). Acute coronary syndromes (ACS) and sudden death cause most IHD-related deaths, which represent 1.8 million deaths per year. The incidence of IHD in general, and of ACS, increases with age although, on average, this occurs 7–10 years earlier in men compared with women. ACS occurs far more often in men than in women below the age of 60 years but women represent the majority of patients over 75 years of age. The risk of acute coronary events in life is related to the exposure to traditional cardiovascular risk factors. This can be estimated using risk scores, such as the European Society of Cardiology SCORE system. Huge differences within European and world regions can be found in the incidence and prevalence of IHD and ACS as well as in case fatality rates. However, information on the incidence of ACS is still limited for Europe. While the incidence of non ST-segment elevation ACS has remained relatively stable, the incidence of ST-segment elevation myocardial infarction has suffered a significant decrease in recent years. Furthermore, the majority of European countries experienced substantial decreases in age-standardized death rates for cardiovascular diseases and IHD in the last decades, particularly for myocardial infarction. This is the consequence of the improvement in cardiovascular prevention and ACS treatment but this trend may be reverting due to population ageing and the increase in some risk factors.