Emilio Ortega ^1,2,3,4* Idoia Genua ^5,6,7 Manel Mata-Cases ^2,8 Mercè Roqué ^4,9 Bogdan Vlacho ^10,2 Jordi Real ⁸ Josep Franch-Nadal ^11,2,8 Didac Mauricio ^12,2,5,8*

• ¹ Department of Endocrinology & Nutrition Service, Hospital Clinic of Barcelona, Barcelona, Balearic Islands, Spain
• ² DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Catalonia, Spain
• ³ CIBER of physiopathology of obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Asturias, Spain
• ⁴ August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain
• ⁵ Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau,, Barcelona, Catalonia, Spain
• ⁶ Department of Medicine, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Catalonia, Spain
• ⁷ Sant Pau Institute for Biomedical Research, Barcelona, Catalonia, Spain
• ⁸ Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, (CIBERDEM), Barcelona, Catalonia, Spain
• ⁹ Service of Cardiology, Hospital Clínic Cardiovascular Institute, Hospital Clinic of Barcelona, Barcelona, Catalonia, Spain
• ¹⁰ CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
• ¹¹ Primary Health Care Center Raval Sud, Gerència d’Àmbit d’Atenció Primaria, Institut Català de la Salut, Barcelona, Balearic Islands, Spain
• ¹² Departament of Medicine,University of Vic - Central University of Catalonia, Vic, Catalonia, Spain

Background: Cardiovascular (CV) diseases are the most common cause of death worldwide. This study aimed to investigate the incidence and type of first CV event in a broad cohort of Spaniards, focusing on age and sex differences.Methods: This was a retrospective study using the SIDIAP database. Subjects aged 30-89 years in 2010 were included. Individuals with prevalent CV disease or atrial fibrillation were excluded. Subjects were followed until the occurrence of a CV event, death, or the study end (December 2016). CV outcomes (coronary heart disease [CHD], cerebrovascular or peripheral artery disease and heart failure [HF]) during follow-up were analyzed. Clinical, anthropometrical, and laboratory data were retrieved from clinical records.Results: Overall, 3,769,563 at-risk individuals (51.2 ± 15.2 years) were followed for a median of 7 years. The cumulative incidence of a first CV event was 6.66% (men vs. women, 7.48% vs. 5.90%), with the highest incidence (25.97%) among individuals >75 years. HF (29%) and CHD (28.8%) were the most common first events overall; in men it was CHD (33.6%), while in women it was HF and cerebrovascular disease (37.4% and 27.4%). In younger age groups, CHD was more prevalent, with HF in older age groups. Baseline CV risks factors conferred more risk in younger ages and differed between men and women.Conclusions: The incidence and type of the first CV event in this Mediterranean region were significantly influenced by age and sex. This information is relevant for tailoring primary prevention strategies including the treatment of risk factors.