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Aim: This study aimed to evaluate whether lower socioeconomic status (SES) is related to a higher risk of recurrent cardiovascular disease (CVD) events and reduced CVD-free life expectancy in a large cohort of patients with established CVD., Methods: 9,477 patients with established CVD from the Utrecht Cardiovascular Cohort - Secondary Manifestations of ARTerial disease (1996-2022) study were included. SES scores were determined at the neighbourhood level using scores provided by the Netherlands Institute for Social Research, based on income, education and unemployment. The relationship between SES and recurrent CVD events was analysed using Cox proportional hazard models, adjusted for age, sex, and traditional CVD risk factors. Event-free life expectancy across SES quintiles was assessed using Kaplan-Meier survival estimates, with age as the time scale and accounting for competing risks., Results: Over a median follow-up of 9.0 years (IQI: 4.8-14.1), 2,090 recurrent CVD events occurred. Unfavourable CVD risk factors were more prevalent among low SES patients, who less frequently used preventive drug treatment. After adjusting for age and sex, patients in the lowest SES quintile had a higher risk of recurrent events compared to the highest SES quintile (HR: 1.35; 95%CI 1.17-1.56). This relationship persisted after adjusting for CVD risk factors potentially mediating the effect. The median event-free life expectancy was 5.5 years (95%CI 2.8-8.0) shorter comparing the lowest to highest SES quintile., Conclusions: Among patients with established CVD, lower SES is related to a higher risk of recurrent CVD events independent of CVD risk factors, and to a shorter CVD-free survival. These findings underscore the need for targeted interventions to reduce health disparities., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: There is little information on the prevalence of hypertension and other modifiable cardiovascular risk factors in community-dwelling elderly in the Netherlands and the potential impact of improving antihypertensive treatment on major cardiovascular events., Design: Cross-sectional analysis of Dutch community-dwelling subjects aged 70-78 years without dementia who were included in the cluster randomized preDIVA trial (Prevention of Dementia by Intensive Vascular care)., Methods: The prevalence of hypertension and other cardiovascular risk factors are described for participants with and without a history of cardiovascular disease (CVD). Projected benefits of blood pressure decrease are calculated using data from a meta-analysis and a large national registry., Results: Of 3534 subjects, more than one-third (n = 1230, 35.2%) have a history of cardiovascular disease. Overall, 63% of subjects have two or more cardiovascular risk factors amenable to treatment. Systolic blood pressure (SBP) is ≥160 mmHg in 37% of patients with CVD, of which 28% is untreated. In subjects without a history of CVD, 41% have a SBP ≥ 160 mmHg of which 52% is untreated. A 5-15 mmHg decrease in SBP is projected to prevent 12-32% of coronary heart disease and 16-41% of strokes, respectively. This corresponds with 14-38 prevented cases within 2 years in our intervention group (n = 1895)., Conclusions: Hypertension and other cardiovascular risk factors are very common in elderly subjects. Current (primary and secondary) prevention programmes appear insufficient. Improved antihypertensive treatment has the potential to prevent a substantial proportion of strokes and coronary heart disease in this population.