This study compared cardiovascular and noncardiovascular prescribing and mortality in patients with takotsubo syndrome (TTS) with those with myocardial infarction (MI) and the general population. The study included 620 patients with TTS, 620 patients with MI, and 2,480 individuals from the general population in Scotland between 2010 and 2017. Electronic health records were used to analyze mortality and medication use. The median follow-up period was 5.5 years. Overall, 153 patients with TTS died, compared to 195 with MI and 374 in the general population. Patients with TTS had higher cardiovascular mortality (HR: 2.47) than the general population but lower than those with MI (HR: 0.61). Noncardiovascular mortality was similar between TTS and MI patients. Cardiovascular therapies were associated with better survival in MI patients but not in TTS patients. Diuretic, anti-inflammatory, and psychotropic therapies were associated with worse outcomes in TTS patients. The study found that cardiovascular mortality was the leading cause of death in TTS patients, and this was not associated with cardiovascular therapy use. The results suggest that further research is needed to understand the mechanisms and treatments for TTS. The study also highlights the need for randomized controlled trials to evaluate the effectiveness of therapeutic interventions in TTS. The findings indicate that the long-term prognosis of TTS is comparable to MI, but the specific causes of increased mortality remain unclear. The study also found that hormone replacement therapy did not affect outcomes, which is unexpected given the theory that perimenopausal hormone changes may predispose women to TTS. The study has limitations, including the potential for bias due to the retrospective nature of the data and the lack of information on why certain medications were prescribed or discontinued. Overall, the study provides important insights into the management and outcomes of TTS.This study compared cardiovascular and noncardiovascular prescribing and mortality in patients with takotsubo syndrome (TTS) with those with myocardial infarction (MI) and the general population. The study included 620 patients with TTS, 620 patients with MI, and 2,480 individuals from the general population in Scotland between 2010 and 2017. Electronic health records were used to analyze mortality and medication use. The median follow-up period was 5.5 years. Overall, 153 patients with TTS died, compared to 195 with MI and 374 in the general population. Patients with TTS had higher cardiovascular mortality (HR: 2.47) than the general population but lower than those with MI (HR: 0.61). Noncardiovascular mortality was similar between TTS and MI patients. Cardiovascular therapies were associated with better survival in MI patients but not in TTS patients. Diuretic, anti-inflammatory, and psychotropic therapies were associated with worse outcomes in TTS patients. The study found that cardiovascular mortality was the leading cause of death in TTS patients, and this was not associated with cardiovascular therapy use. The results suggest that further research is needed to understand the mechanisms and treatments for TTS. The study also highlights the need for randomized controlled trials to evaluate the effectiveness of therapeutic interventions in TTS. The findings indicate that the long-term prognosis of TTS is comparable to MI, but the specific causes of increased mortality remain unclear. The study also found that hormone replacement therapy did not affect outcomes, which is unexpected given the theory that perimenopausal hormone changes may predispose women to TTS. The study has limitations, including the potential for bias due to the retrospective nature of the data and the lack of information on why certain medications were prescribed or discontinued. Overall, the study provides important insights into the management and outcomes of TTS.