To observe the risk factors characteristic of patients developing acute coronary syndrome, ischemic or hemorrhagic stroke in a Chinese population aged 35 - 64 (n = 30 378). This prospective study was carried out in 11 provinces in China from 1992 to 2003. The association between baseline risk factors and events in the 10-year follow-up period was analyzed. (1) A total of 809 events were recorded during the follow up period and 227 with acute coronary syndrome, 582 with stroke (ischemic 419, hemorrhagic 146, undefined 17) and the 10-year cumulative person-year incidence rates were 114/100,000, 209/100,000 and 73/100,000 for acute coronary syndrome, acute ischemic stroke and acute hemorrhagic stroke, respectively. (2) Rate of having > or = 1 modifiable risk factors was significantly higher in event group than that in subjects without events (89% vs. 64.7%, P < 0.01). (3) Sorted by intensity, the sequence of independently risk factors obtained from multivariate analysis for acute coronary syndrome were hypertension, smoking, hypercholesterolemia and low-HDL-C; for acute ischemic stroke event were hypertension, diabetes, low-HDL-C, smoking and obesity; for acute hemorrhagic stroke was hypertension. The morbidity for cardiovascular diseases is higher in Chinese population with various traditional risk factors than those without or having fewer traditional risk factors and there are various distinct independent risk factors pattern in patients with different cardiovascular diseases subtypes.