This review summarizes the incidence, prevalence, mortality trends, and prognosis of coronary heart disease (CHD) and acute coronary syndrome (ACS). Although CHD mortality has decreased in Western countries over the past decades, it remains a leading cause of death, accounting for about one-third of all deaths in individuals over 35 years of age. The mortality rate is expected to increase in developing countries, highlighting the need for effective primary prevention strategies globally. CHD is a major cause of death and disability in developed countries, with the Framingham Heart Study providing critical insights into risk factors for CHD. Non-communicable diseases are becoming more prevalent, with factors such as physical inactivity, nicotine abuse, and poor nutrition contributing to increased prevalence in many countries. Social inequalities and negative lifestyle factors also contribute to higher CVD mortality. Incidence and prevalence of CHD and ACS have been studied extensively. In the U.S., approximately 15.5 million people aged 20 years or older have CHD, with prevalence increasing with age. The incidence of CHD has decreased in developed countries, but the experience varies globally. CHD is the leading cause of death in adults in the U.S., with a 38% decline in annual death rates from CHD between 2003 and 2013. Mortality rates for CHD have decreased in most developed countries, but the situation is different in developing countries, where CHD mortality is expected to increase significantly. Sudden cardiac death (SCD) is a common complication of CHD, occurring in 15% of patients with CHD. SCD is the most frequent type of death in patients with CHD, accounting for 30-50% of events. The risk of SCD is higher in patients with a low left ventricular ejection fraction. Women have a lower risk of SCD compared to men, and the risk is generally proportional to the risk of CVD, with a lag of more than 10 years. MI is a significant risk factor for SCD, doubling the risk compared to angina. The review also highlights the importance of early detection and management of CHD, including the role of cardiac troponins in diagnosing MI. Silent myocardial infarction is common, with approximately 2-4% of the general population having silent coronary ischemia. Silent MI is strongly associated with age, and its incidence increases with age. The prognosis of patients with silent MI is similar to that of patients with clinically recognized MI, but the risk of mortality is higher in those with unrecognized MI. In conclusion, CHD remains a major public health issue, with significant mortality and morbidity in both developed and developing countries. Effective primary prevention strategies are essential to reduce the burden of CHD globally. The review emphasizes the need for continued research and public health initiatives to address the challenges posed by CHD and ACS.This review summarizes the incidence, prevalence, mortality trends, and prognosis of coronary heart disease (CHD) and acute coronary syndrome (ACS). Although CHD mortality has decreased in Western countries over the past decades, it remains a leading cause of death, accounting for about one-third of all deaths in individuals over 35 years of age. The mortality rate is expected to increase in developing countries, highlighting the need for effective primary prevention strategies globally. CHD is a major cause of death and disability in developed countries, with the Framingham Heart Study providing critical insights into risk factors for CHD. Non-communicable diseases are becoming more prevalent, with factors such as physical inactivity, nicotine abuse, and poor nutrition contributing to increased prevalence in many countries. Social inequalities and negative lifestyle factors also contribute to higher CVD mortality. Incidence and prevalence of CHD and ACS have been studied extensively. In the U.S., approximately 15.5 million people aged 20 years or older have CHD, with prevalence increasing with age. The incidence of CHD has decreased in developed countries, but the experience varies globally. CHD is the leading cause of death in adults in the U.S., with a 38% decline in annual death rates from CHD between 2003 and 2013. Mortality rates for CHD have decreased in most developed countries, but the situation is different in developing countries, where CHD mortality is expected to increase significantly. Sudden cardiac death (SCD) is a common complication of CHD, occurring in 15% of patients with CHD. SCD is the most frequent type of death in patients with CHD, accounting for 30-50% of events. The risk of SCD is higher in patients with a low left ventricular ejection fraction. Women have a lower risk of SCD compared to men, and the risk is generally proportional to the risk of CVD, with a lag of more than 10 years. MI is a significant risk factor for SCD, doubling the risk compared to angina. The review also highlights the importance of early detection and management of CHD, including the role of cardiac troponins in diagnosing MI. Silent myocardial infarction is common, with approximately 2-4% of the general population having silent coronary ischemia. Silent MI is strongly associated with age, and its incidence increases with age. The prognosis of patients with silent MI is similar to that of patients with clinically recognized MI, but the risk of mortality is higher in those with unrecognized MI. In conclusion, CHD remains a major public health issue, with significant mortality and morbidity in both developed and developing countries. Effective primary prevention strategies are essential to reduce the burden of CHD globally. The review emphasizes the need for continued research and public health initiatives to address the challenges posed by CHD and ACS.