A priority in preventive cardiology is to reduce the number of recurrent events and to prolong survival in patients with established coronary heart disease (CHD). Aim of the present study was to examine risk factors for long-term mortality in CHD patients who entered routine secondary prevention after a coronary event or intervention. Such patients, from the EUROASPIRE (EUROpean Action on Secondary Prevention through Intervention to Reduce Events) I and II studies in the region of Münster, Germany, were followed over a mean period of 8.0 years up to the end of 2005. Patients were up to 70 years of age at baseline when they were interviewed and examined using standardised methods. Baseline examination was carried out at least 6 months and at a mean of 19.5 months after the coronary event or procedure. In 367 patients from EUROASPIRE I and 380 patients from EUROASPIRE II, a total of 125 deaths (16.7%) occurred during follow-up. Multivariate analyses, using Cox proportional hazards models, established diabetes mellitus and smoking as predictors for all-cause mortality with estimated hazard rate ratios (HRRs) of 2.24 (95% confidence interval (CI): 1.43-3.49) and 1.95 (95% CI: 1.23-3.10), respectively. Significant associations were found between diabetes mellitus and cardiovascular (HRR 2.36; 95% CI: 1.31-4.24) as well as CHD mortality (HRR 2.40; 95% CI: 1.25-4.59). Systolic blood pressure was significantly associated with increased cerebrovascular disease mortality (HRR 1.04; 95% CI: 1.01 and 1.08 for 1 mmHg increase). In conclusion, long-term mortality in coronary patients from routine secondary prevention is substantial. Diabetes mellitus and smoking represent key issues in patients with established CHD.