OBJECTIVES To estimate annual incremental healthcare costs of new cardiovascular (CV) events (myocardial infarction, unstable angina, revascularization, ischemic stroke, transient ischemic attack or heart failure) in patients with hyperlipidemia or prior CV events. METHODS A retrospective population-based cohort study was conducted using Swedish electronic medical records and national registers. Patients were included in the study based on a prescription of lipid-lowering treatment between January 1, 2006 and December 31, 2006 or history of CV events (prior to 2006) and followed until December 31, 2012 for identification of new CV events and estimation of cost. Patients were stratified into three cohorts based on CV risk level. Propensity score matching was applied to compare patients with new events to patients without new events and to estimate incremental costs. RESULTS A new CV event resulted in increased costs during all follow-up years. Inpatient hospital stays were the main driver of the increase. The majority of the costs occurred in the first year following event when patients with CV event history (n=6,881) had an incremental cost of 74,758 SEK. This was similar to that of CV risk-equivalent patients (n=3,226; 75,415 SEK) and patients at low/unknown CV risk (n=2,497; 72,635 SEK). Ischemic stroke resulted in the highest first year cost in all cohorts (88,739; 85,516; and 87,668 SEK) and transient ischemic attack the lowest (34,098; 36,042; and 29,052 SEK). Incremental costs during subsequent years remained elevated for all cohorts, with the CV event history cohort having the highest costs. Second year incremental costs varied between 10,689 and 15,082 SEK and third year costs varied between 8,828 and 11,558 SEK across cohorts. CONCLUSIONS The direct costs of new CV events were substantial and varied considerably by type of event. Costs were increased during all follow-up years, regardless of CV risk level.