OBJECTIVES:   To examine the demographic and clinical characteristics, and cardiovascular treatment in patients with high-risk vascular disease (HRVD). METHODS:  A large employer-based US administrative claims database was used to conduct this retrospective cohort study. Patients with HRVD (defined as cerebrovascular disease [CVD], coronary artery disease with diabetes [CADD], peripheral artery disease [PAD], or history of acute coronary syndrome [ACS] [≥30days through 365 days after discharge for ACS]) between October 1, 2008 to September 30, 2009, ≥65 years of age, were identified with minimum 12-month pre- and 24-month post-index health plan eligibility. Patients’ baseline demographic characteristics, comorbidities, and medication use were examined and compared across groups with and without polyvascular disease. RESULTS:  There were 525,893 HRVD patients identified with an average age of 77.2 years and gender of 51.0% male. Of the identified patients, 59.5% had hypertension, 32.9% had hypercholesterolemia, and 44.7% had diabetes. Patients were generally undertreated with statins (50.3% HRVD; range: 44.9% PAD to 64.0% CADD), antiplatelets (21.4% HRVD; range: 16.8% CVD to 49.7% ACS), beta-blockers (41.8% HRVD; range: 35.2% CVD to 67.1% ACS), and other evidence-based risk reduction therapies. Patients with >1 affected artery bed (18%) had numerically similar age (age: 77.1, 77.6, 77.0 for 1, 2, 3 affected disease beds), but had higher cardiovascular risk factors (for 1, 2, 3 affected disease beds, hypertension: 57.2%, 69.1%, 73.4%; hypercholesterolemia: 32.0%, 36.6%, 37.3%; diabetes: 40.5%, 61.2%, 83.9%), and used more cardiovascular-related medications (statins: 48.0%, 59.9%, 67.5%; antiplatelets: 18.3%, 33.8%, 48.8%; beta-blockers: 39.0%, 53.3%, 64.4%) compared to patients with only 1 affected disease bed (p<0.01). The average number of medications per patient was 9.1 for HRVD patients, ranging from 7.6 for CVD-alone patients to 17.7 for patients with ACS, CADD, CVD, and PAD (N=1456). CONCLUSIONS:  In elderly HRVD patients, classic cardiovascular risk factors are consistent and common, but are undertreated in the U.S.