OBJECTIVES: To assess the cost utility analysis of lifestyle interventions (diet, physical activity and diet+physical activity) at primary care for person with high risk of cardiovascular disease by using a Markov model. METHODS: A cost-utility analysis was performed using a 10-state Markov model of CVD (cardiovascular disease) events applied to a cohort of 60 year-old men from the county of Stockholm, Sweden. A previously performed randomized controlled trial of dietary advice, physical exercise and diet+physical exercise on middle aged men of Sweden (The Sollentuna study) was used as effectiveness of intervention. The risk of having a CVD event in primary care was taken from The Framingham Heart Study. Lifetime costs and health effects (QALYs, quality-adjusted life-years) were estimated, in both a health care and societal perspective with 3% discount rate. RESULTS: The model predicts physical exercise to be the best option at zero willingness to pay and dietary advice the best if the decision-maker willingness to pay is higher than 60,000 SEK per QALY (1 Euro= 10.74 SEK (2009). The incremental cost-effectiveness ratio (ICER), compared with no intervention is 77,000 SEK/ QALY from a health care perspective and 57,000 SEK/QALY from a societal perspective. CONCLUSIONS: Based on the model estimates, dietary advice and physical exercise both are cost-effective interventions, and the choice depends upon the decision-maker willingness to pay.