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ObjectivesTo assess the importance of biomedical risk factors, social factors and self-reported health in the prediction of the first event of acute myocardial infarction (AMI) in an apparently healthy middle-aged population. DesignAn incident case–control study. SettingThe study was nested within the Västerbotten Intervention Program and the Northern Sweden MONICA cohorts. SubjectsThe study consists of 78 AMI cases with two randomly selected controls per case from the same study cohorts. ResultsSignificant odds ratios were found for history of diabetes, daily smoking, cholesterol, body–mass index, hypertension, lower education and perceived ill health. In multivariate logistic regression smoking, hypertension and cholesterol of ≥7.8 mmol L-1 remained significant. An interaction was observed between number of biomedical risk factors and perceived health. ConclusionsSmoking, hypertension and hypercholesterolaemia explain a major share of incident AMI events in a Swedish middle-aged population. The study further illustrates that perceived ill health negatively modifies the impact of these risk factors. [ABSTRACT FROM AUTHOR]