Modification of risk factors in patients who have had myocardial infarctions has received little attention in the literature. Yet, major modifiable risk factors for recurrent coronary heart disease, including hypertension, smoking, increased serum cholesterol levels, sedentary lifestyle, and obesity are the same risk factors for its development. Although coronary atherosclerosis is already established in patients who have had a myocardial infarction, evidence suggests that important reductions in recurrent coronary heart disease and death can be achieved through secondary prevention programs that modify risk factors. The high risk for recurrence and mortality in patients who survive a heart attack means that substantial reductions in the rates of these events can be achieved with relatively small reductions in risk factors. Patients who have had a myocardial infarction are also active participants in health care and are likely to be highly motivated to modify their risks for cardiac disease.