Objective-We tested the hypothesis that short telomere length is associated with increased risk of myocardial infarction, ischemic heart disease, and early death. Methods and Results-We measured leukocyte telomere length in 2 prospective studies of 19 838 Danish general population participants from the Copenhagen City Heart Study and the Copenhagen General Population Study. Participants were followed for up to 19 years for incident myocardial infarction (nϭ929), ischemic heart disease (nϭ2038), and death (nϭ4342). Follow-up was 100% complete. Telomere length decreased linearly with increasing age in women and men in both studies (Pϭ7ϫ10 Ϫ74 to Pϭ3ϫ10 Ϫ125 ). Multifactorially adjusted hazard ratios were 1.10 (95% CI 1.01-1.19) for myocardial infarction, 1.06 (1.00 -1.11) for ischemic heart disease, and 1.09 (1.05-1.13) for early death per 1000 -base pair decrease in telomere length. The multifactorially adjusted hazard ratios for the shortest versus the longest decile of telomere length were 1.49 (1.07-2.07) for myocardial infarction, 1.24 (1.01-1.53) for ischemic heart disease, and 1.25 (1.07-1.46) for early death. Conclusion-Short telomere length is associated with only modestly increased risk of myocardial infarction, ischemic heart disease, and early death. Key Words: acute coronary syndromes Ⅲ ischemic heart disease Ⅲ death Ⅲ myocardial infarction Ⅲ telomere length T elomeres are protective chromosomal caps at the linear ends of chromosomes consisting of a variable number of TTAGGG repeats. 1 Telomeres shorten with each cell cycle in most cells and therefore reflect organism aging at a cellular level. 1,2 Accordingly, telomere length decreases with increasing age 3,4 but also with male sex, smoking, adiposity, oxidative stress, UV irradiation, and low socioeconomic status. 2,3,[5][6][7] It has therefore been a matter of speculation whether short telomere length is associated with increased risk of cardiovascular disease and early death. 5,8 -10 Previous studies of telomere length and human disease have been limited by cumbersome techniques mainly allowing low-throughput measurements. 11 Furthermore, the majority of studies so far have mainly been smaller case-control studies rather than large prospective studies of unselected individuals from the general population. 12 Accordingly, there is a need for large studies of the general population with extended follow-up, with telomere length measured reliably with a high-throughput method to examine the influence of short telomere length on cardiovascular disease and early death.We tested the hypothesis that short telomere length is associated with increased risk of myocardial infarction, ischemic heart disease, and early death. For this reason, we developed a high-throughput real-time polymerase chain reaction assay calibrated to measure absolute telomere length. Subsequently, we measured 19 838 individuals from 2 prospective studies of the Danish general population from the Copenhagen City Heart Study and the Copenhagen General Population Study, followed for u...