Objective Most studies providing data on survival in patients with atherosclerosis only address a single disease site: heart, brain or legs. Therefore, our objective was to determine risk of death after first hospital admission for atherosclerotic disease located at different sites.

Design Hospital-based follow-up study.

Setting and Participants A nationwide cohort of patients hospitalised for the first time for acute myocardial infarction (AMI), peripheral arterial disease of the lower extremities (PAD) or ischaemic stroke was identified through linkage of national registers in 1995, 1997 and 2000. The total population of the Netherlands in 1995, 1997 and 2000 was 15 424 122 (men 7 627 428, women 7 796 640), 15 567 107 (men 7 696 803, women 7 870 304) and 15 863 950 (men: 7 846 317, women: 8 017 633), respectively.

Main Outcome Measure Twenty-eight-day, 1-year and 5-year mortality rate in AMI patients was compared to mortality rate in ischaemic stroke patients and PAD patients by estimating RR (with 95% CI). Cox's proportional hazard models were used to adjust for age.

Results Case fatality was highest for ischaemic stroke patients though lowest for PAD patients. In patients 55 to 74 years, large differences in risk of death were observed between AMI patients and PAD patients (men: RR 9.62; 95% CI 5.78 to 16.02, women: RR 14.28; 95% CI 6.68 to 30.52) In contrast, the 5-year risk of death was similar for male AMI and PAD patients and differences in risks of death between AMI and ischaemic stroke patients largely attenuated.

Conclusions The dynamics of mortality over time clearly differ between atherosclerotic diseases. Short-term mortality is higher for cardiac and ischaemic stroke patients compared to PAD patients. However, the risk of death increases considerably over follow-up times for PAD patients, and 5 years after first hospital admission the differences in risks of death between AMI and PAD patients and between AMI and ischaemic stroke patients have largely attenuated.