OBJECTIVE: To determine the relation between psychological characteristics and subsequent fatal ischaemic heart disease (IHD) events. DESIGN: Prospective study of participants in the Northwick Park heart study (NPHS) recruited between 1972 and 1978 and followed up for fatal events until 1997. SETTING: Three occupational groups in north west London. SUBJECTS: 1408 white men without a history of myocardial infarction aged 40-64 years at entry who completed a Crown-Crisp experiential index form (CCEI). MAIN OUTCOME MEASURE: Fatal IHD during follow up. RESULTS: A one point increase in the score on the obsessionality/obsessional neurosis subscale was associated with a relative risk of fatal IHD of 1.08 (95% confidence interval (CI) 1.02 to 1.15). For the functional somatic complaint subscale the relative risk was also 1.08 (95% CI 1.02 to 1.15). In the case of the total score the relative risk of fatal IHD was 1.28 (95% CI 1.09 to 1.50) for a 10 point increase. The associations were independent of age, social class, and known cardiovascular risk factors. In the case of phobic anxiety, which had previously been found to be associated with fatal IHD in NPHS, the association was evident in the first 10 years of follow up but overall the relative risk was only 1.07 (95% CI 0.99 to 1.15) for a one point increase in the score. CONCLUSION: Scores on two of the subscales of the CCEI and the total score are significantly associated with fatal IHD on long term follow up independently of other known risk factors.