Background Cardiovascular disease mortality remains high in Europe and many patients have elevated risk factors, despite evidence-based targets and treatment guidelines. This survey examined barriers to implementing cardiovascular risk reduction guidelines. Design We conducted a semi-structured market research survey of physicians. Methods The survey was conducted in six European countries among cardiologists and primary care physicians. In total, 67 questions were used: 35 had multiple choice answers (prompted) and 32 allowed any answer (unprompted). Respondents were working full-time in patient care (≥3 years experience) and were in a position to initiate cardiovascular drug treatment. Results Of the 220 respondents (155 primary care physicians, 65 cardiologists), most (85%) based assessment of cardiovascular risk on all risk factors, reflecting a global approach to risk, rather than considering risk factors individually. A majority (62%) used subjective assessments for establishing global risk rather than guidelines or risk calculators. The most common unprompted barrier to guideline implementation was patient compliance (36%) and a lack of time (23%), and when prompted, the most important was government health policy (40%). The most common unprompted suggestion for improving implementation were financial opportunities (24%) and clear and easy to use guidelines (23%), while when prompted the most important change required was the development of simpler guidelines (46%). Conclusions Although a majority of physicians are aware of the need to look at a combination of cardiovascular disease risk factors, less than half use guidelines or risk calculators to determine total risk. It is recommended that guidelines need to be simpler and easier to use and supplemented with (patient friendly) risk calculators.