OBJECTIVES Cardiovascular events (CVE) are the number one cause of death (42%) in Germany. This study evaluates available literature regarding direct medical costs related to CVE in Germany. The CVE of interest were myocardial infarction (MI), unstable angina, heart failure (HF), stroke, and peripheral artery disease (PAD). Update of a review conducted in 2012. METHODS A systematic literature search was performed in the following databases- Medline, Embase, Centre for Reviews and Dissemination, TIBORDER, and German dissertation database from 01/2003 to 10/2013. Observational studies and randomized clinical trials were considered for the review. RESULTS The search identified 400 publications; 13 were included in this review. For MI, average hospitalization costs during acute phase were between € 5,836 and € 7,522 per admission (PA). In the first year after a MI, direct medical costs were € 11,672 - 12,713 per patient. Average costs of treating unstable angina were € 2,217 - 3,644 PA. Direct medical costs of chronic HF patients were between € 3,150 - 4,792 per patient per year. Average treatment costs for hospitalized PAD in the acute phase were € 4,186 PA, € 2,138 during month 1-6 after initial hospitalization, € 1,350 in month 7-12, and € 1,172 in month 13-18. For stroke, total direct medical costs in year one were € 11,408 per patient. Total direct medical costs during the 1st year after an ischemic stroke event were € 15,573 - 18,517 per patient, € 5,280 in month 13-18, and € 5,479 per year in the subsequent 4 years. CONCLUSIONS MI, unstable angina, HF, stroke and PAD have a high financial impact on the German health care system. Treatment costs in the first year after event were highest for MI with €11,672 – 12,713 per patient followed by stroke with €11,408 per patient demonstrating need for improvement in preventing CVE.