Objective To evaluate 10-year risk of ischemic cardiovascular diseases (ICVD) in middle-aged adults in Henan province to provide evidence for improved health status. Methods The 10- year risk of ICVD in 12 064 middle-aged adults was evaluated by using simplified risk estimation model. Results About 96. 35% of male and 98. 29% of female had a probability of < 10% to develop ICVD over 10 years; 3.65% of male and 1.71% of female had a probability of ≥ 10% to develop ICVD over 10 years; and 0.68% of male and 0.23% of female had a probability of≥20% to develop ICVD over 10 years. The prevalence of risk factors for ICVD in two absolute risk groups ( ≥10% vs < 10% ) was significantly different. Conclusions The risk of ICVD in the middle-aged residents of Henan province may be similar to that in the middle-aged Chinese adults. The risk assessment for ICVD could be used for high- risk populations.