In the United States the prevalence of stroke at midlife is double in women than men of the same age. Little is known about current sex-specific trends in symptomatic cardiovascular disease (Neurology 2007; 69 (20): 1898-1904). The aims of this study were: to assess temporal trends in sex disparities in MI prevalence among individuals at midlife and to assess temporal trends in sex disparities in the risk of future hard cardiovascular events among midlife in individuals without a history of myocardial infarction (MI). The authors assessed the sex specific MI prevalence and the Framingham coronary risk score (FCRS) among US adults aged 35 to 54 years who participated in the National Health and Nutrition Examination Surveys (NHANES), cross sectional, nationally representative surveys during 1988 to 1994 and 1999 to 2004. The results of the study are: 1) in men aged 35 to 54 years prevalence of MI is higher than in women at the same age, 2) MI prevalence decreased among men and increased among women (2.5% vs 0.7% in NHANES 1988-1994 and 2.2% vs 1.0% in NHANES 1999-2004; 3) the mean FCRS showed an improving trend in men (8.6% in NHANES 1988-1994 vs 8.1% in NHANES 1999-2004; 4) the mean FCRS worsened in women (3.0% in NHANES 1988-1994 vs 3.3% in NHANES 1999-2004); 5) temporal trends in FCRS components revealed that men had more improvements in vascular risk factors than women; 6) diabetes mellitus prevalence increased in both sexes. The conclusions are very interesting: 1) over the past two decades MI prevalence has increased among midlife women, while it was declining among men of the same age; 2) the risk of future hard cardiovascular events remains higher in midlife men compared to midlife women; 3) the gap has narrowed in recent years.