Objective-Nonhyperlipidemic postinfarction patients are at high risk for recurrent coronary events by virtue of incident myocardial infarction (MI); however, few studies assess risk beyond incident MI. The aim of this study was to assess such risk as a function of 37 atherosclerosis-associated genetic polymorphisms and 17 blood marker variables. Methods and Results-Screening of polymorphisms in nonhyperlipidemic postinfarction patients revealed significant risk only for the 4G/5G insertion/deletion polymorphism in the promoter of the plasminogen-activator inhibitor-1 (PAI-1) gene. Outcome event mapping, an exploratory data analysis tool, was then applied to define a subgroup (182 patients from total study population of 846 nondiabetic patients) exhibiting maximal functional dependence of risk on the PAI-1 polymorphism. Cox multivariable regression analyses within the subgroup adjusted for significant clinical covariates and medication use as a function of the PAI-1 polymorphism and 17 atherosclerosis-associated blood markers revealed significant risk for patients homozygous for the 4G allele (hazard ratio 4.30, 95% CI 1.98 to 9.33, Pϭ0.00023), and lack of significant risk-association with any blood marker. Conclusions-In a subgroup of normolipidemic postinfarction patients, only the PAI-1 4G/5G polymorphism was associated with recurrent risk from a set of atherosclerosis-associated genetic polymorphisms and blood markers. A lthough hypercholesterolemic postinfarction patients are at high risk for recurrent coronary events, normocholesterolemic postinfarction patients suffer recurrent events as well. 1 Beyond incident myocardial infarction (MI), traditional and nontraditional risk factors play a role 2,3 although little specific information is available especially for normolipidemic postinfarction patients. 4 In a previous report on nondiabetic patients of the Thrombogenic Factors and Recurrent Coronary Events (THROMBO) postinfarction study, when lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) was included in models, it resulted in replacement of apolipoprotein B (apoB) as the only risk factor of recurrent coronary events from a set of thrombogenic, inflammatory, and metabolic blood markers. 5 To determine predictors of risk for recurrent events in normolipidemic postinfarction patients, we studied nondiabetic THROMBO patients (nϭ846) as a function of a set of 37 genetic markers associated with cardiovascular disease (CVD) followed by studies with a set of 17 thrombogenic, inflammatory, and metabolic blood markers. 5 Preliminary screening of genetic markers in normolipidemic (cholesterol Ͻ5.17 mmol/L, triglycerides Ͻ1.69 mmol/L) study patients revealed most significant risk for the 4G/5G insertion/deletion polymorphism (4 or 5 sequential guanosines, respectively) of plasminogen activator inhibitor-1 (PAI-1), a major inhibitor of fibrinolysis. The polymorphism is located in the gene promoter region (chromosome 7) and results in allele-specific responses to multiple agents. 6 Accordingly, studies have shown th...