OBJECTIVE: The objective of this study was to describe the burden of modifiable risk factors and of the total CV risk in a population, free of CVD, selected in general practice, on the basis of age (40-75 yrs) and waist circumference (>=94 cm in men and >=80cm in women). METHODS: In total, 619 Belgian GPs recruited consecutive patients during spring 2004. A central lab analysed fasting blood samples. RESULTS: Complete data on 8587 patients were obtained. Mean age was 58 yrs (47% women). Mean BMI and waist were 30.1 kg/m2 and 99 cm for women and 30.1 kg/m2 and 107 cm for men. Eighteen-percent had diabetes (D) either known and treated (14%) or newly detected, based on fasting glucose levels (4%). Of the non-diabetic subjects (ND), 25% had °Ý3 metabolic syndrome risk factors (NCEP-ATP III criteria). Twenty-four percent of the total population was smoking and 84 % did not engage in regular physical activity. Seventy-seven percent of ND had LDL cholesterol >=115 mg/dl & 78% of D had LDL cholesterol >=100 mg/dl. Only 31% of subjects on lipid lowering drugs had TC<190 and LDL<115 mg/dl. 49% of ND had BP>=140/90 mmHg and 91% of the D had BP>=130/80 mmHg. Total CV risk in the ND was estimated using the SCORE chart calibrated for Belgium. Total risk >=5% for dying from CVD in the coming 10 yrs was present in more than 40% of men and in more than 20% of women. CONCLUSION: Waist measurement is an easy and inexpensive tool to detect, in the middle-aged population free of CVD, a subgroup with a large variety of modifiable risk factors and at high risk for CV death. A large majority of them is physically inactive, an unacceptable proportion is smoking and both total cholesterol and blood pressure are insufficiently managed.