OBJECTIVES: To estimate acute, short-term and long-term healthcare costs among hyperlipidemia patients following a cardiovascular event (CVE). METHODS: This retrospective cohort study examined hyperlipidemia patients (≥1 medical claim and/or ≥1 prescription for lipid-lowering therapy) using longitudinal administrative claims data from a large commercial US insurer. Those with a CVE and those without a CVE were propensity score matched to adjust for differences in demographics, comorbidities, and coronary heart disease risk. Qualifying CVEs were MI, ischemic stroke, PCI, CABG, unstable angina, TIA or heart failure. Patients were followed from index (date of first CVE or a randomly selected date for those w/o a new CVE) until the earlier of disenrollment, 8/31/12, or 36 months after the index. Analyses reported here are limited to commercially enrolled CVE patients and their matched no CVE pair. The payer perspective was taken for all analyses with cost representing the total health plan + patient paid amounts.  Mean ±SD costs are presented for the following periods: acute (days 0-30), short-term (days 31 to 365), 2nd year (days 366-730) and 3rd year (days 731-1095). RESULTS: The study included 156,679 pairs. Acute costs were $23,213±41,561 and largely driven by inpatient costs ($18,040±39,805). Acute costs among those with no CVE were significantly less at $799±4,037 (p<0.001). Costs in the short-term were $18,532±48,721 ($6,484±15,948 for no CVE, p<0.001), 2nd year costs were $15,335±43,438 ($4,396±13,326 for no CVE, p<0.001) and 3rd year costs were $14,210±38,681 ($2,704±9,783 for no CVE, p<0.001). CONCLUSIONS: Acute costs are highest in hyperlipidemia patients with a CVE compared to those without. The main driver of costs following a CVE was inpatient hospitalizations. Although costs decline in the short- and long-term, costs of patients with CVEs remain high for several years compared to hyperlipidemia patients without CVEs.