OBJECTIVES: To assess, in a community setting, the clinical and economic outcomes of hypercholesterolemic patients with ACS and diabetes treated with statins over a one-year follow-up. METHODS: Data for over 2.9 million subjects were extracted from 6 Local Health Units (ARNO Observatory, an administrative database containing data on hospitalizations, prescriptions and diagnostic/outpatient visits). The index period lasted from January 1 to  December 31, 2011. Patients with ACS and diabetes were followed-up from the index hospitalization in 2011 for a period of 1 year. The rate of prescription, dosage, adherence to statin treatment and related health care costs were evaluated. RESULTS: Of 2,989,512 subjects identified, 6,226 patients (0.2%) were hospitalized for ACS: 86.4% were aged over 60 years. Hospital death rate was 4.1%. Among ACS cases, 1,917 had diabetes (30.8%). At 1-year follow-up, 85.3% of patients with ACS and diabetes, were prescribed statin therapy with 84.9% being prescribed high intensity statins (Atorvastatin 40, 80 mg/dL, Rosuvastatin 20, 40 mg/dL). Adherence to treatment (attributed to all patients who received the correct daily dosage during the one year follow-up period with a 20% tolerability – CORE Study 2013) was higher among high intensity statins users compared to lower intensity statins users (67.1% vs 38.9%). Over the 1-year follow-up period, 69.3% of ACS diabetic patients were re-hospitalized, of which 55.6% were hospitalized for cardiovascular events. The average yearly cost per patient supported by NHS was 16,897€/year: 14,199€ for hospitalizations; 1,691€ for drugs; 1,008€ for diagnostic and outpatient visits. CONCLUSIONS: Patients with ACS and diabetes have high direct healthcare costs, with re-hospitalization being the main cost driver. Adherence to statin treatment was sub optimal. Local Health Authorities together with Cardiologists and GPs are working to bridge the gap between evidence-based recommendations and clinical practice in order to contain morbidity and health costs.