OBJECTIVES: To evaluate the short- (first year) and long-term (second year) cost of cardiovascular events (CVEs) in Belgium. METHODS: The analysis included myocardial infarction (MI, excluding revascularization), unstable angina (UA, excluding revascularization), heart failure (HF), ischemic/hemorrhagic stroke (IS/HS) and transient ischemic attack (TIA). Coronary revascularization procedures (weighted average of coronary artery bypass grafting [CABG] and percutaneous coronary intervention [PCI]) were also evaluated. Index hospitalization costs (year 2012) as well as re-hospitalization costs up to 2 year after the index hospitalization were derived from the Belgian IMS real-world Hospital Disease Database (HDD). Other follow-up costs (rehabilitation, outpatient visits and ambulatory resource use [tests, imaging and drugs]) over 2 years were assessed by an independent 2-round expert-panel in 2014 (5 cardiologists, 6 neurologists). Costs of fatal CVEs were evaluated through the HDD. The combined perspective of public health care payer and patient was applied. Costs (€ in 2014) were calculated as unit costs (official listings) multiplied by the number of resources used. RESULTS: Total costs in the first year after CVEs ranged between €7,683 (UA) and €33,790 (HS). Costs for TIA, MI, HF and IS were €8,198, €11,119, €17,210 and €24,640, respectively. Follow-up costs over the second year ranged from €2,781 (UA) to €7,617(HS). Other CVEs costed €3,315 (TIA), €3,746 (MI), €7,233 (HF) and €7,399 (IS) in year 2. Hospitalization costs were the most important cost driver, independent of CVE type. Follow-up costs tended to be higher in patients with increased CVE risk. Revascularization costs were €13,373 and €2,763 during the first and second year of follow-up, respectively. Fatal events costed €4,698 (HS), €5,424 (UA), €6,122 (MI), €7,643 (IS) and €10,344 (HF). Patient co-payment varied between 3-11%. CONCLUSIONS: CVEs account for a significant economic burden in Belgium. Hospitalizations are the most important cost driver. Prevention of hospitalizations could lead to important savings.