OBJECTIVE: To determine the presence of cardiovascular events (CVEs) and their association with the main cardiovascular risk factors (CVRFs) and resource utilization parameters (direct costs) in subjects with chronic obstructive pulmonary disease (COPD) in different Spanish primary care centers. METHODS: A retrospective-multicenter design was adopted, with inclusion of the patients seen for COPD (ICPC:R95) by four primary care teams and two hospitals during 2004. The main measures were: age-sex, cardiovascular antecedents (ischemic heart disease [IHD], cerebrovascular accident, hypertension, dyslipidemia, diabetes mellitus, smoking, obesity) and other co-morbidities, clinical parameters (FEV1, BMI), resources utilization (complementary tests, pharmaceutical prescription, specialist referral, physician visits, hospitalizations and emergency-room visits, ambulatory care) and costs (semifixed and direct). A logistic regression analysis was made to fit the model. The costs were contrasted by covariance analysis (ANCOVA-marginal means). Data were analyzed using SPSS-v12 and p values of <0.05 were taken as the level of statistical significance. RESULTS: Nine-hundred patients were seen for COPD; mean age 70.4±9.8 years and 85.3% were males. Around 19.0% (n=171) had undergone a CVE (CI: 16.4-21.6%); 15.1% with IHD. The main CVRFs were: 44.1%-hypertension, 36.2%-obesity, 31.9%-dyslipidemia, 23.6%-diabetes and 22.7%-smoking. The mean morbidity/patient/year was 10.1±4.2 with CVEs vs. 8.3±4.3 (p=0.000); the clinical parameters studied (FEV1, BMI) showed no significance. The logistic model, corrected for age-sex and severity identified as associated factors: diabetes mellitus (OR=2.1; CI=1.3-3.4; p=0.001) and dyslipidemia (OR=1.7; CI=1.1-2.7; p=0.002). Quantification of unit cost/year/COPD was 2793.22±3166.30€ (70.5% pharmaceutical expenditure). The cost/year/patient-adjusted was €2847.22 (SE=117.02) without CVEs, versus €2563.66 (SE=244.05) with CVEs, p=NS. CONCLUSIONS: The presence of CVEs associated with COPD is high, causing an important co-morbidity, though without increasing the global costs of the disease. Diabetes mellitus and dyslipidemia are the main CVRFs associated; their prevention could improve the disease outcomes. Further studies are needed to confirm the consistency of these results.