With increased emphasis on prevention in recent healthcare reform initiatives, more information is needed to validate the effectiveness of programs designed to diagnose and treat individuals at high risk for cardiac events and increased mortality. The purpose of this study was to evaluate early and late outcomes of a community-based cardiovascular risk reduction program (CRRP). Methods: Individuals at high risk for cardiovascular events were referred from community primary care physicians for advanced diagnostic testing and medication management at a hospital-based CRRP. Between March 1, 2005 and August 1, 2007, 182 participants were enrolled and had advanced lipid testing, chemistry panels, stress testing, CT calcium scoring, vascular elasticity studies, and comprehensive assessment of cardiovascular risk factors, family history, diet, activity level and psychological status. Participants had on average 4 visits. Mortality and need for hospitalization were assessed at a mean follow-up time of 45±14 months. Results: On CRRP entry, 84% had elevated lipids, 70% had hypertension, 31% had diabetes, 32% had metabolic syndrome, 10% were current smokers, 17% had an abnormal stress test, 36% had depression, 44% had sleep disturbances, and over 50% were not exercising. Over 30% had conditions that had not been recognized or were left undertreated. By last visit, over 95% of participants were on appropriate medications and had received life-style interventions. Late mortality occurred in 9 (5%) participants and 15 (8%) had at least one hospitalization for cardiac reasons. Those who died were older (67 vs. 56; p=0.007), had significantly higher CT calcium scores (998 vs. 114; p<0.0001) and elevated homocysteine levels (14 vs. 9; p<0.0001). Multivariate analyses showed that homocysteine level was the only independent predictor of mortality. No one with metabolic syndrome died (p=0.038). The only factor related to hospitalization was higher NCEP Framingham Age/Sex-adjusted risk score (18 vs. 12; p=0.037). Conclusions: A comprehensive community-based risk reduction program can provide enhanced evaluation and treatment for individuals who are at high risk for cardiovascular events. Appropriate medications and risk modification may impact late events.