ObjectivesThis study aims to understand the magnitude of and mechanisms underlying the development of cardiovascular events (CVEs) in patients with invasive pneumococcal disease (IPD). We aimed to identify factors that contribute to the occurrence of CVEs within one year after admission and discuss implications for patient care. MethodsA multicentered cohort study, including adult patients from four Dutch hospitals who had a positive blood culture for S. pneumoniae and any type of clinical manifestation between 2012-2020. Disease characteristics and microbiological data were systematically collected from electronic patient files. Main outcome measures were the occurrence of stroke and acute coronary syndromes (ACS). ResultsOf 914 eligible patients, 4.2% experienced a CVE within one year after admission for IPD. ACS mainly occurred in the first two weeks, whereas stroke developed throughout follow-up. While ACS were positively associated with disease severity, the sole independent predictor was alcohol abuse (OR 3.840, 95% CI 1.108-13.303). Although stroke occurred in 6.3% of meningitis cases, the best clinical predictor of stroke was a body temperature >39.5°C at admission (OR 3.117 (1.154-8.423). In the adult IPD population <70 years old, pneumococcal serotypes were the primary predictors of ACS (7F; OR 15.733 (1.812-136.632)) and stroke (22F; OR 7.320 (1.193-44.903)). ConclusionAdverse cardiovascular events were not uncommon after IPD diagnosis and deserve attention, especially in the high risk groups we identified in our study population. Whether specific serotypes play a role in the development towards CVE requires substantiation in further research.