Objective Global cardiovascular risk assessment has been incorporated into current Chinese guidelines for the management of hypertension and hypercholesterolemia. The aim of our study is to determine the distribution of 10-year risk for ischemic cardiovascular disease (ICVD) among middle-aged Chinese adults, and to evaluate the usefulness of global risk assessment tools in the primary prevention of ICVD in Chinese population.Methods Simplified prediction tools derived from the USA-PRC Collaborative Study of Cardiovascular Epidemiology cohort were applied to the Chinese Health Examination Database (CHED) 2008. 10-year risk for ICVD was estimated in 461 157 ICVD-free subjects (264 432 male and 196 725 female) aged 35 to 59 years. Results Among the male subjects, 82.4% had a 10-year risk for ICVD of <5%, 14.4% of 5% to 12.1 % and 3.4 of≥12.2%, and in female subjects, 86.7% had a 10-year risk for ICVD of <5%, 12.1% of 5% to 12.0% and 1.2% of ≥12.1 %. All subjects with predicted high level ICVD risk (≥ 12.2% in male or ≥ 12.1% in female) had either remarkably elevated (≥160 tnmHg) blood pressure, significantly increased (≥6.22 mml/L) total serum cholesterol or diabetes.Conclusion Using the currently recommended prediction tools, only very small proportions of middle-aged Chinese men and women who were free of ICVD would be classified into high level risk group. These prediction tools are unlikely to help for the medical intervention decision making in Chinese adult patients with hypertension and/or hypercholesterolemia.