OBJECTIVES: A study was undertaken to compare the epidemiology and costs associated with primary prevention of coronary heart disease (CHD) in males in France, Germany, Italy, Spain and the United Kingdom. METHODS: Country-specific epidemiological and cost data were collected as part of an economic evaluation of CHD and analysed for differences between countries. Epidemiological and economic data were collected for men in eight five year age groups (35-39 to 70-74 years). These data were primarily obtained from the published literature and complemented by expert opinion. RESULTS: Mean systolic blood pressure ranged from 125 to 132 for the 35-39 year olds and from 143.9 to 155.5 for the 70- 74 year olds. Mean body mass index ranged from 24.7 to 26.9 for the 35-39 year olds and from 25.5 to 27.75 for the 70-74 year olds. The proportion of smokers ranged from 0.38 to 0.56 for the 35-39 year olds and from 0.2 to 0.29 for the 70-74 year olds. With adjustment by the respective health purchasing power parities, direct costs of CHD ranged from £11,515 to £20,431 for acute myocardial infarction, £8,484 to £17,898 for complicated angina, £606 to £10,227 for uncomplicated angina and £305 to £9,734 for sudden and non-sudden death. CONCLUSIONS The epidemiological data showed similar trends within the five countries with some observed differences for certain variables and/or age groups. Resource utilization data differed significantly between countries - a non-surprising finding considering the profound differences in health care systems and treatment patterns across Europe. However, differences in currency values and unit costs make direct comparison of costs difficult.