OBJECTIVES: To assess the healthcare costs and resource utilization of patients with high risk vascular disease (HRVD) METHODS: A retrospective cohort study was conducted using a large employer-based U.S. administrative claims database. This study included patients aged 18 to 64 years who had 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 10/01/2008 and 09/30/2009, with minimum 12-month pre-index and 24-month post-index insurance eligibility. Annual healthcare costs and resource utilization were compared across HRVD patients with 1, 2, or 3 affected arterial beds for the first and second year follow-up periods. The comparison of mean costs between cohorts was conducted using a generalized linear model with log link function and gamma distribution. RESULTS: Of 152,290 patients who met the selection criteria, 54.4% were male with mean age 54.5(SD=7.5). Among the identified HRVD patients, during the first/second year, 6.8%/4.3% had ≥ 1 hospitalization event and 27.2%/21.5% had ≥ 1 ER visit. The mean annual number of physician office visits was 22/18 for the first and second year respectively. Mean total annual healthcare costs per HRVD patient for the first and second year were $19,003/$18,547, of which outpatient costs were $9,698/$8,530, inpatient costs were $6,286/$6,220, and pharmacy costs were $3,018/$3,797. HRVD-related costs during the first ($8,699) and second year ($7,925) accounted for close to half of the overall total healthcare costs. Mean total annual costs in the first and second year were $17,820/$17,501, $28,060/$26,554, and $39,306/$36,513 for patients with 1, 2, and 3 affected arterial beds (P<0.001).   CONCLUSIONS: These results show the high economic burden of HRVD and the especially high economic burden associated with HRVD patients with multiple affected arterial beds.