Objectives To examine temporal trends in the incidence and recurrence of hospitalised coronary heart disease (CHD), cerebrovascular disease (CeVD) and peripheral arterial disease (PAD) separately and combined, and by the history of all forms of atherothrombotic disease (ATD).

Design Population-based longitudinal data linkage study.

Setting Western Australia.

Participants All patients aged 35–84 years hospitalised in Western Australia for CHD, CeVD or PAD from 2000 to 2007.

Main Outcome Measures Age-standardised incidence and recurrence rates of CHD, CeVD and PAD stratified by ATD history, sex and age.

Results 107 576 events (65.9% men) were identified; 70% of all admissions were for CHD. In patients without a history of any ATD, incidence rates declined significantly in all groups, although the reduction in incident CHD in women was marginal (−0.7%/year, 95% CI −1.5 to +0.1%). The largest annual reductions in incidence rates were for PAD (men, −6.4%/year, 95% CI −7.7 to −5.0%; women, −5.4%/year, 95% CI −7.2 to −3.6%) and CeVD in women (−4.0%/year, 95% CI −5.0 to −3.0%). Falls in overall recurrence rates were greatest for CeVD (men, −3.2%/year, 95% CI −4.7 to −1.6%; women −4.6%/year, 95% CI −6.4 to −2.7%). Trends across all categories of polyvascular ATD were generally downward, although not all changes were statistically significant.

Conclusion The incidence and recurrence rates of hospitalised ATD have decreased over time, including in patients with disease involving multiple vascular territories. This implies that primary and secondary prevention strategies have been broadly effective. However, high absolute rates of recurrence and limited reduction in 35–54-year-old individuals highlight patient groups to target to reduce further the burden of ATD.