Introduction and objectives The routine medical check-up provides a good opportunity for screening workers early for cardiovascular risk factors. The aim of the present study was to investigate the prevalence of cardiovascular risk factors in the Spanish working population. Methods The study included 216 914 working people (mean age 36.4 years, range 16-74 years, 73.1% male), undergoing routine medical check-up, which involved a structured questionnaire, physical examination, and standard serum biochemical analysis. Results Cardiovascular disease had been diagnosed previously in 0.7% of workers, hypertension in 6.2%, diabetes in 1.2%, and dyslipidemia in 8.9%. Routine check-up showed that 49.3% (51.3% of males and 43.8% of females) were smokers, 22.1% (27.0% of males and 8.8% of females) had high blood pressure (≥140/90 mm Hg), 15.5% (18.3% of males and 13.3% of females) were obese (body mass index ≥30), 6.2% (7.8% of males and 1.9% of females) were hyperglycemic (blood glucose >110 mg/dL), and 64.2% had dyslipidemia (total cholesterol ≥200 mg/dL, LDL cholesterol ≥160 mg/dL, triglycerides ≥200 mg/dL, or HDL cholesterol <40 mg/dL in males or <50 mg/dL in females). When compared with workers in the service sector and after adjustment for potential confounders, workers in manufacturing, and particularly those in construction, had higher prevalences, of both high blood pressure and smoking. Conclusions The prevalence of cardiovascular risk factors in the Spanish working population is high, particularly in males and in certain types of employment.