OBJECTIVES: To assess in a community setting the clinical characteristics, the outcomes and the related costs of patients admitted for an acute coronary syndrome (ACS) or a stroke/TIA (CVD) or a peripheral artery disease (PAD). METHODS: From the ARNO Observatory, we carried out a record linkage analysis of discharge records for ACS and prescription databases, which included 2,989,512 subjects of 7 Local Health Authorities from Northern to Southern Italy. The accrual period lasted from January 1 to December 31, 2011. RESULTS: Of the 2,989,512 subjects, 6,226 (2.1‰) were hospitalized for ACS, 9,939 (3.3‰) for a CVD and 1,048 (0.4‰) for PAD. Patients admitted for CVD were significantly older  and of female gender than patients with ACS or PAD (age 75 ± 13 vs 71 ± 13 vs 73 ± 11, p<0.001) (gender 50.6% vs 35.5% vs 31.9%, p <0.001). In-hospital mortality rate was 6.9%, 4.6% and 1.0% (p<0.001) respectively for CVD, ACS and PAD. Over the 1-year follow-up, 63.3% of the patients with ACS needed to be readmitted again vs 49.1 of those with CVD and 57.6% of PAD. The average yearly cost per patient for the ACS population was 16,897€/year (drugs, 1,692€; hospitalizations, 14,198€; diagnostic and outpatient visits, 1,007€), for the CVD 10,440€/year (drugs, 1,135€; hospitalizations, 8,745€; diagnostic and outpatient visits, 560€) and for PAD 14,872€/year (drugs, 1,649€; hospitalizations, 11,781€; diagnostic and outpatient visits, 1,442€). CONCLUSIONS: In a large and representative community setting, CVD patients have a worse in-hospital outcome than patients with ACS or PAD. However, the costs for the NHS were higher for patients with ACS or PAD being the main cost driver the need for further readmissions during the follow-up period.