OBJECTIVES: It is well-known that cardiovascular risk is higher in diabetes patients but real-life country level data are scarce. The aim of this study was to compare the cardiovascular event rate and relevant outcomes in patients with and without diabetes in Belgium. METHODS: Event rates, average length of stay (LOS) and mortality among hospitalized patients were estimated using the longitudinal IMS Hospital Disease Database (2007), including data on 34.3% of Belgian hospital beds, combined with Belgian population data. Stays were identified based on ICD-9 or DRG coding. Acute coronary syndromes (ACS) included Myocardial infarction (ICD-9:410-411.89) and unstable angina (ICD-9:411.1-411.8-413.0). Cerebrovascular disease (CVD) was defined as stroke (APR-DRG:045;046) and Transient Ischemic Attack (DRG:047). Confidence intervals around relative risks (RR) were calculated to compare proportions and LOS using a Wilcoxon non-parametrical test.  RESULTS: In 2007 there were 10.5 million inhabitants including 450,000 diabetics. The incidence of first ACS was 5 times higher in diabetes patients (7.7 per 1000 inhabitants vs. 1.5; RR 5.04 [4.86-5.23]). Average LOS in diabetic ACS patients was 3 days longer (10.8 vs. 7.2 days; p<0.001) and mortality during hospitalization was 38% higher (10.79% vs. 7.84%; RR 1.38 [1.14-1.66]). Recurrence within a calendar year of ACS occurred in 27% of the diabetic patients vs. 21% of the non-diabetics (RR 1.28 [1.20-1.36]). The CVD incidence was 11.3 per 1000 inhabitants in diabetics and 2.1 per 1000 in non-diabetics (RR: 5.26 [5.10-5.42]). In diabetic patients LOS was 4 days longer (18.5 vs. 14.5 days;p<0.001), mortality during hospitalization slightly higher (9.47% vs. 8.78%; RR 1.08 [0.94-1.24]) as well as recurrence (5.11% vs. 4.62%, RR 1.11 [0.99-1.23]). CONCLUSIONS: Patients with diabetes do not only have a significantly higher risk of ACS and CVD, they also stay longer in the hospital, and in ACS have a significantly higher in-hospital mortality and recurrence.