Climate change can lead to an increase in major adverse cardiovascular events (MACE), but little is known about the long-term effects of this change on the prevalence of hospitalizations for stroke and acute myocardial infarction (AMI) in tropical drylands. Therefore, this study evaluated the association between trends in stroke and AMI hospitalizations and climatic variables (CVs) (2008-2019) in a large tropical semi-arid region at municipality scale. Initially, the trend components of the monthly time series for hospitalizations due to stroke, AMI, and CVs were calculated. Then, the association between the trends in stroke and AMI hospitalizations and CVs was analyzed using a generalized additive model. Finally, the study investigated whether the trends in stroke and AMI hospitalizations and CVs for each municipality were increasing, decreasing, or insignificant. Among the 14 municipalities studied, all showed a significant association between stroke and AMI hospitalizations and CVs, with the association being more pronounced for AMI than for stroke. Overall, MACE showed an increasing trend, with 10 municipalities exhibiting an increasing trend for stroke and 12 for AMI. The increasing trend in stroke and AMI was associated with a rising trend in air temperature and with a declining trend in wind speed. No consistent pattern was found for absolute humidity and precipitation. This study supports the need to implement strategies for the prevention of MACE, considering the impact of climate change, such as monitoring open space meteorological variables, extreme heat campaigns, and the implementation of urban green spaces.