Shared environmental factors may confer to spouses a similar risk for cardiovascular disease. We aimed at investigating in pairs the concordance in risk factors for cardiovascular disease and in global risk of cardiovascular events. In the framework of the IMMIDIET Project, married couples, recruited randomly from general practice, were studied. One thousand six hundred and four apparently healthy subjects aged 25-74 years from three different European populations were enrolled. Individual cardiovascular risks were estimated using SCORE risk equations. Age was strongly correlated within couples (r = 0.86, P < 0.0001). In multivariate model, within-pair correlation was high for social status (r = 0.49; percentage of explained variation = 24%) and percent of calories from lipids (r = 0.34; 12%). Concerning conventional metabolic risk factors, percentage of explained variation varied from 0.5% (triglycerides) to 11% (glucose). Among new risk factors, activated factor VII showed the strongest correlation (r = 0.28) and C-reactive protein the lowest (r = 0.13). Either total, coronary or non-coronary risk estimates at 10 years were strongly correlated within pairs: the risk of a member explained about two thirds of the cardiovascular risk of the partner. Spouse pairs share common lifestyle habits, common and new metabolic risk factors and the predicted global risk of cardiovascular events. If the individual risk of a person is influenced by the risk of his/her partner, decreasing the risk in a member of the pair should also decrease the risk in the partner. These concepts may have important public health consequences in targeting screening or disease prevention measures towards partners of people with cardiovascular risk.