Abstract Background To determine if major depressive disorder (MDD) in older primary care patients is an independent risk factor for cardiovascular events. Methods A cohort of 143 primary care patients with depression and 139 non-depressed controls without depression (both aged over 55 years, matched for age and gender) from the Netherlands was evaluated for 2 years. MDD was diagnosed according to DSM-IV–criteria. During the follow-up period, information was collected on physical health, depression status and behavioural risk factors. CVD end points were assessed with validated annual questionnaires and were crosschecked with medical records. Results Thirty-four participants experienced a cardiovascular event, of which 71 % were depressed: 27/134 with MDD (20.1 %) and 9/137 controls (6.6 %). MDD was associated with a hazard ratio of 2.83 ( p value 0,004, 95 % CI 1.32 to 6.05) for cardiovascular events. After adjustment for cardiovascular medication, the hazard ratio was 2.46 (95 % CI 1.14 to 5.30). Conclusions In a 2-year follow-up period, baseline MDD increased the risk for CVD in older primary care patients compared with controls, over and above well-known cardiovascular risk factors.