OBJECTIVES: To determine the co-morbidity influence and the direct cost according to cardiovascular risk levels (CRL) in patients older than 55 years appertaining to population setting and in clinical practice. METHODS: Multicentric design, realized beginning from registers of subjects ≥ 55 years appertaining to a seven centres of primary care (year 2006). The calculation of the CRL was effected using Framingham-Wilson equation: low risk (<10), moderate (10-19), high (20-29) and very high (≥30). Main measures: general (age, gender, etc.), cardiovascular co-morbidities (CIAP-2), cardiovascular events- CVE (criteria: NCEP-ATP III), Charlson-index (patient severity) and cost model. The general morbidity charge was measured beginning from Adjusted-Clinical Groups (http://www.acg.jhph.edu). Fixed/semifixed costs were considered (structure, salary, services) and variable ones (diagnostics/therapeutics requests, referrals, drugs). An analysis of logistical regression and the covariance (ANCOVA) was affected for the correction of the models (procedure: Bonferroni), according to the recommendations of Thompson-Barber. Program SPSSWIN; p<0.05. RESULTS: From 24,441 subjects older than 55 years, were attended 12,828. The 30.1% (IC 95%:29.3-30.9%) showed a high/very high CRL. All studied variables in bivariant relation were related to CRL. Increase of CRL was associated as an independent way to man (OR=7.1), diabetes (OR=6.8), smoking (OR=5.8), hypertension (OR=2.3), dislipemia (OR=1.9), obesity (OR=1.4), CVE (OR=1.3) and age (OR=1.2), p<0.001). The unitary cost average adjusted by age-gender and Charlson-index was increased according to CRL category: low: €986.14; moderate: €1021.20; high: €1107.64 and very high €1328.09; p<0.001. These results were obtained in all analysed components. Pharmaceutical cost represented 66.2% of the total. CONCLUSIONS: Subjects with high CRL showed older age, high morbidity (diabetes, smoking, hypertension) and CRL presence, existing gender differences (man) with high consume of sanitary resources. There are a high margin of improvement in the primary prevention of health, were should be established cost-effective measures to promote intervention strategies in this patients collective.