BACKGROUND: The burden of cardiovascular diseases (CVDs) is much more pronounced in Eastern Europe, a spatial gradient within Europe still exists. However, former studies showed a significantly lower CVD mortality of German repatriates from the Former Soviet Union compared with the German population. METHODS: All-cause, CVD and ischemic heart disease (IHD) standardized mortality ratio (SMR), IHD standardized incidence ratio and annual age-standardized mortality and acute myocardial infarction (AMI) incidence rates were calculated in a retrospective cohort. Time trends were investigated by loess regression. RESULTS: A total of 6378 German repatriates were observed from 1990 to 2010, accumulating 92 149 person-years. We observed a lower all-cause mortality [SMR = 0.86 (0.75, 0.98)] in females and CVD mortality [International Statistical Classification of Diseases and Related Health Problems, version 10 (ICD) 10: I00-I99; SMR = 0.82 (0.65, 1.03)] and IHD mortality (I20-I25) [SMR = 0.84 (0.60, 1.15)] in males. In contrast, AMI incidence was significantly higher in male repatriates [standardized incidence ratio = 1.30 (1.02, 1.65)]. Whereas in the general population, mortality rates of CVD, IHD and AMI incidence have continuously decreased over time, the pattern in the repatriates was not as clear. In male repatriates, mortality rates seemed to be lower after immigration and remained rather constant. Incidence rates possibly exceed Germans rates by now. CONCLUSIONS: A possible historical repatriates' IHD advantage shown in former studies has disappeared. The increasing AMI incidence in (male) repatriates might demonstrate the delaying onset of the impact of changes in the CVD risk profile due to migration. Health politics and the health system should be sensitized and take care of the development of IHD mortality and AMI incidence among the repatriates.