For a study, the researchers sought to determine if temporal alterations in early repolarization pattern (ERP) were linked to a higher risk of sudden cardiac death (SCD) and cardiovascular death. The ARIC (Atherosclerosis Risk in Communities) study included 14,679 middle-aged participants from a prospective, population-based cohort, with ERP status assessed at baseline and during 3 follow-up visits. Baseline ERP, time-varying ERP, and temporal variations in ERP were linked to cardiovascular outcomes. The hazard ratios (HRs) were calculated using Cox models that were adjusted for potential confounding factors. There were 5,033 fatalities, 1,239 cardiovascular deaths, and 571 SCDs after a median follow-up of 22.5 years. SCD (HR, 1.59 [95% CI, 1.25–2.02]), cardiovascular mortality (HR, 1.70 [95% CI, 1.44–2.00]), and death from any cause (HR, 1.16 [95% CI, 1.05–1.27]) were also linked to time-varying ERP. About 3 outcomes were also linked to baseline ERP. Subjects with new-onset ERP or constant ERP had a higher chance of developing SCD and dying from cardiovascular disease than those with consistently normal ECG readings. Women, White participants, and anterior leads with Jwave amplitudes more than or equal to 0.2 mV appeared to have worse cardiovascular outcomes. In the middle-aged multiracial sample, the outcomes implied that baseline ERP, time-varying ERP, new-onset ERP, and consistent ERP were all independent predictors of SCD and cardiovascular death. Repeated ERP measurements might improve its use as a risk indicator for SCD.