OBJECTIVES: Assess associations between the Deyo-Charlson comorbidity index (DCI) score and cardiovascular disease (CVD) event risk among primary (PR) and secondary risk (SR) dyslipidemia patients in a managed care setting. METHODS: A retrospective analysis of patients aged ≥ 18 years with laboratory results from a complete first lipid panel (index date) between January 1, 2002-February 28, 2005 was performed using an integrated managed care research database. Inclusion criteria were patients with minimum of 12 months pre- and post-index date follow-up, without lipid-modifying medication use at least 6 months prior to index date, and at least one of LDL-C, HDL-C, or TG at sub-optimal level per multiple national treatment guidelines. Associations between pre-index DCI score and 3-year CVD event risk was estimated between PR and SR patients using a multivariate logistic regression model after controlling for demographic and clinical variables. RESULTS: A total of 45,716 patients were identified, 57.8% (n=26,407) were PR. Statistical significance was observed between the 2 groups at baseline in terms of percent males (SR: 56.7% vs. 48.3%: PR; p<0.0001), DCI score (SR: 0.16 ± 0.43 vs. PR: 0.64 ± 0.72; p<0.0001), LDL-C (SR: 129.4 ± 35.1 vs. PR: 126.7 ± 34.8 mg/dL; p<0.0001), HDL-C (SR: 42.0 ± 11.2 vs. PR: 48.4 ± 14.0 mg/dL; p<0.0001), and TG (SR: 179.1 ± 79.3 vs. PR: 161.1 ± 79.1 mg/dL; p<0.0001). Regression analysis showed that every one unit increase in pre-index DCI score was associated with a 34% [Odds Ratio (OR): 1.34 (1.27-1.41); p<0.05] higher likelihood to experience a CVD event at 3 years among SR patients versus 32% [OR: 1.32 (1.20-1.46); p<0.05] for PR patients. CONCLUSIONS: SR dyslipidemia patients with a higher DCI score were associated with a higher CVD event risk versus PR patients. Further research on this association and subsequent impact on long-term clinical and economic outcomes is needed.