The interplay between demographic and epidemiologic evolutions is presented exemplified for cardiovascular diseases in Germany. The actually 82 million inhabitants of Germany build the frame for disease occurrence; currently, 2.1 million men and 4.4 million women are > or = 75 years old. The ongoing increase of life expectancy to 75.6 years in men and 81.3 years in women was associated with a remarkable decrease of cardiovascular and ischemic heart disease (IHD) mortality and an increasing disease-specific mean age of death. Each third male and each fourth female death from IHD could be prevented, whereas the absolute number of nonfatal acute myocardial infarction (AMI) increased in the younger ages and decreased in the higher age groups. Since 1985, the total number of fatal and nonfatal cases of AMI has decreased by 24% in men and by 22% in women; two thirds of male and one third of female cases occur before the 75th year of age. These positive trends are mainly the result of a more effective acute and long-term therapy after AMI onset. Actually, 35% of all AMI patients do not survive the first day after acute onset and in up to 90% of them classic risk factors (hypertension, dyslipidemia, diabetes, cigarette smoking) were present. Therefore, the theme number 1 for the population must be intensified activities of primary prevention.