The role of classical risk factors, particularly high blood pressure, high blood cholesterol levels, and cigarette smoking in predicting incidence of heart disease has been well documented. However, information about the predictive value of these risk factors in persons who already have heart disease is largely derived from selected hospital or case series with limited time of follow-up and predominantly involving men. We examined the role of risk factors in predicting subsequent all-cause and cardiovascular disease mortality in a population of men and women, age 50 to 79 years (mean age, 66 yr), who reported a history of heart disease at baseline examination and who have been followed for nine years. One hundred ninety-one men and 96 women reported a personal history of heart attack or heart failure. In these men, age, high systolic blood pressure, and family history of heart attack were significant independent predictors of mortality attributable to cardiovascular disease and all causes. In contrast, only current cigarette smoking habit and personal history of diabetes significantly predicted increased mortality in these women. High systolic blood pressure in men and cigarette smoking in women appear to be the two major potentially remediable risk factors for mortality in older subjects with a history of heart disease.