OBJECTIVE: Cost-effectiveness analysis of treatments to reduce cholesterol concentration, blood pressure and smoking for the primary prevention of coronary heart disease in Catalonia (Spain) was assessed in this study. METHODS: Cost-effectiveness was measured in terms of met cost per life year gained (LYG), comparing costs and benefits from coronary heart disease in individuals aged >30 years with hypercholesterolemia >200 mg/dl, moderate/severe (DBP > 105 mmHg) and mild (DBP 95-104 mmHg) hypertension and smoking. Cost-effectiveness ratios were calculated for 1998 using a 5% discount rate. RESULTS: Cost-effectiveness ratios obtained in this study ranged from €2,608 to €8,058 per LYG for smoking cessation therapies, from €7,061 to €81,027 per LYG for moderate/severe hypertension treatment, from €10,877 to €126,990 per LYG for mild hypertension treatment, and from €12,792 to €142,910 per LYG for dietary and pharmaceutical treatment of hypercholesterolemia. Incremental cost-effectiveness analysis showed that lovastatin (HMG-CoA reductase inhibitor) was more cost-effective than cholestyramine (bile acid sequestrant) and gemfibrozil (fibrate) in individuals with hypercholesterolemia, hydrochlorothiazide (diuretic) and propranolol (beta-adrenergic antagonist) were more cost-effective than captopril (angiotensin-converting-enzyme inhibitor), prazosin (alpha-adrenergic antagonist) and nifedipine (calcium channel blocker) in individuals with moderate/severe hypertension treatment, and hydrochlorothiazide and nifedipine were more cost-effective than propranolol, prazosin and captopril in individuals with mild hypertension treatment. CONCLUSION: When resources for the primary prevention of coronary heart disease are limited, the priority order based on cost-effectiveness analysis was smoking cessation, hypertension treatment and hypercholesterolemia treatment.