OBJECTIVES: “De Todo Corazón” is a risk management program to reduce complications and improve the quality of life of patients with cardiovascular risk. The aim of this study was to estimate the direct medical costs related to confirmed stroke in a insured population enrolled in a risk management program in Colombia-2015. METHODS: We retrospectively collected data from 380 patients with confirmed stroke enrolled in a cardiovascular risk management program of a subsidized insurer who presented arterial hypertension (AH) or AH+ type 2 diabetes mellitus (DM2). We designed a top-down analysis to estimate direct medical costs due to stroke from a third payer perspective. Costs were calculated based on hospitalization billing records and expressed in US Dollars 2015. Median costs and interquartile ranges (IQR) were described by age group, risk level and risk factors. RESULTS: In total, 50% of patients who suffered a stroke had as underlying cause DM2+AH. According to the Framinhan risk score, 22.9% of the patients were classified as low-risk, 2.4% as intermediate, 32.6% as high and 42.1% were unclassified. The median costs of hospital care due to a stroke per patient by risk groups were $864 (IQR $2,414), $730 (IQR $3,141) and $1,902 (IQR $4,256) for low, intermediate and high-risk patients, respectively. By risk factor groups, the median cost for patients under-65 with DM2+AH was $1,531 (IQR $3,536) and $1,876 (IQR $ 4,796) for ≥65 years. Patients under-65 years who presented only HTA had median costs of $805 (IQR $937) and ≥65 years of $1,561 (IQR $ 3,077). Differences in cost per age group regarding to risk factors were statistically significant (Wilcoxon rank-sum p<0.01). CONCLUSIONS: Direct costs of stroke care increased with risk level and age. Our results are important to design policies focused on the cost and risk management of patients with cardiovascular disease.