The purpose of this study was to evaluate changes in the prevalence of cardiovascular disease (CVD) risk factors in a population-based sample of Greek adults.From May 2001 to December 2002, 1514 men and 1528 women (age >18 y), living in the Attica region of Greece, were enrolled in the ATTICA cohort study. In 2006, the 5-year follow up was performed (941 of the 3042 participants, 31%, were lost to follow up). The prevalence of hypertension, hypercholesterolemia, diabetes, obesity, smoking and physical inactivity, was assessed in both examinations through established procedures. Development of CVD (coronary heart disease, acute coronary syndromes, stroke, or other CVD) during the followup period was defined according to the WHO-ICD-10 criteria.During 2001-2006 there were 88 male and 102 female cases with hypertension per 1000 individuals, 237 male and 177 female cases with hypercholesterolemia per 1000 individuals, 58 male and 53 female cases with diabetes per 1000 individuals. In addition, 304 per 1000 males and 294 per 1000 females who were physically active at baseline examination became sedentary during the follow-up period. The prevalence of obesity reduced in males by 0.7% (p=0.66), but increased in females by 2.4% (p=0.10). Regarding smoking, its prevalence in 2001 was 47.2% in males and 39.6% in females; however, 27.5% of males and 24.5% of females stopped smoking, while 21.7% of males and 24.7% of females started smoking during the study period. The 5-year incidence of CVD was 11.0% in men and 6.1% in women (p<0.001); the case fatality rate was 1.6%.The burden of CVD risk factors is increasing at alarming rates in the investigated population. Our data underline the need for immediate action from public health care professionals in order to control the upcoming epidemic.