The most useful phenotypic measures of fibrinolysis in prediction of myocardial infarction currently appear to be tissue-type plasminogen activator (t-PA) antigen and fibrin D-dimer. Recent meta-analyses of prospective studies show significant associations with incident ischaemic heart disease (including myocardial infarction) after adjustment for classical risk factors. The odds ratio in the top third versus the bottom third for baseline values was 1.5 (95% confidence interval 1.2-1.8) for t-PA antigen, and 1.7 (95% confidence interval 1.3-2.2) for D-dimer. Further studies are required to establish with confidence the associations for plasminogen activator inhibitor type 1, urokinase-type plasminogen activator, and other fibrinolytic variables.