OBJECTIVES : To evaluate the occurrence of acute readmissions of patients in secondary prevention for Atherosclerotic Cardiovascular Disease (ASCVD) using Health Information Systems (HIS) in Italy. METHODS : Retrospective observational study on claims database from Marche and Umbria regions (1.8 million of inhabitants), including patients aged 18-80 years with one or more hospitalizations for Acute Coronary Syndrome (ACS), Ischemic Stroke and Transient Ischemic Attack (IS), and Peripheral Artery Disease (PAD). Patients were discharged between 2009 and 2012 for Marche and between 2011 and 2014 for Umbria, and should have had at least 2 prescriptions of lipid lowering therapies (statins and/or ezetimibe) in the 365 days prior to and/or in the 180 days following the first cardiovascular (CV) hospitalization (index-event). Patients were followed up for 2 to 5 years to verify the occurrence of hospitalizations for subsequent CV events (ACS, IS and PAD). Results were stratified by type of index condition (ACS, IS and PAD). CV hospitalization event rates (HER) were calculated for the year following the event, and cumulative incidence of rehospitalization was calculated for patients with 5 years follow-up. RESULTS : 17,881 patients were included; 56.3% with history of ACS, 22.7% of IS and 21% of PAD. First year HER was estimated at 17.6 per 100 patients-year (15.4 for ACS, 13.9 for IS and 28.4 for the PAD cohorts). Additionally, among the 4,690 patients with follow-up information up to 5 years (26.2% of total sample size), 30.3% were hospitalized due to CV events in this period: ACS (27.5%), IS (26.6%) and PAD (42.5%). CONCLUSIONS : The recurrent CV HER in this study provides real-world estimates of CV disease burden in secondary prevention patients in Italy. The high proportion of rehospitalizations in these patients, despite being treated with LLT, highlights the need to improve patient management in a population with a substantial unmet need.