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Background: To investigate the relationship between self-rated health, adjusted for standard risk factors, and myocardial infarction and to discuss self-rated health as a proxy for resilience and existential meaning making.

Method: Population-based prospective cohort study from Västerbotten County, Sweden. Enrolment took place between 1990 and 2004 and persons in the total population aged 40, 50 or 60 were each year invited. Participation rate was 60%. After exclusion for prior stroke or myocardial infarction, or within 12 months after enrolment or death within 12months after enrolment, 72530 persons remained for analysis. Cox regression analysis was used to estimate Hazard Ratios (HR) for the end point of first non-fatal or fatal myocardial infarction. HR were adjusted for age, sex, systolic blood pressure, total cholesterol, smoking, diabetes, body mass index, education, physical activity and self-rated health in the categories very good; pretty good; somewhat good; pretty poor or poor.

Results: Mean follow-up time was 13.2 years. 2062 persons were diagnosed with fatal or non-fatal myocardial infarction. Poor self-rated health adjusted for sex and age was associated with the outcome with HR 2.03 (95% CI 1.45 to 2.84). In a multivariable analysis with standard risk factors HR was attenuated to 1.61 (95% CI 1.13 to 2.31) for poor self-rated health. All categories of self-rated health remained statistically significant.

Conclusion: This study supports the use of self-rated health as a standard risk factor among others for myocardial infarction. Based on prior research, it can be hypothesized that possible causal pathways for the connection between self-rated health and myocardial infarction could be physiological changes in the body measured as allostatic load or cytokine levels. Self-rated health is an inclusive measure. Existential health and existential meaning making and resilience could be essential parts in explaining the connection between self-rated health and myocardial infarction.