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Introduction: Increasing the proportion of adults who attain and maintain low cardiovascular risk profile is essential in the prevention of cardiovascular disease (CVD). It is unknown which factors are associated with attaining and maintaining a low risk profile. We investigate the association of 6 demographic, 4 lifestyle, 3 CVD history, and 4 psychosocial determinants with 1) attaining and 2) maintaining a low risk profile. Method: CVD risk factors and determinants were measured at baseline (1987-1991) and 5-year intervals until 2013 among 6,390 adults initially aged 20-59. Participants were categorized into low risk (i.e., ideal levels of blood pressure, cholesterol, and body mass index, not smoking and no diabetes) and medium or high risk profile. Those with low risk profile maintained or lost their low risk status, whereas those with medium/high risk profiles maintained that risk profile or attained a low risk profile during 5 years follow-up. Determinants of change in risk profiles were examined using modified Poisson regression to obtain risk ratios (RR) and 95% confidence intervals (95%CI) and generalized estimating equations to combine multiple 5-year comparisons. Results: A small proportion of participants (3%) with medium/high risk profile attained a low risk profile during the following 5 years. Compared to those who maintained a medium/high risk profile, one unit increment in Mediterranean (healthy) diet score was associated with 9% (RR: 1.09, 95%CI: 1.02-1.16) and being physically active compared to being inactive with a 104% (RR: 2.04, 95%CI: 1.05-4.00) higher likelihood to attain a low risk profile. Older age (RR: 0.66), male gender (RR: 0.46), low (RR: 0.55) and intermediate (RR: 0.77) education, low education of partner (RR: 0.70), and being a homemaker (RR: 0.73) were significantly associated with lower chance to attain low risk status. Of those having a low risk profile, 40% maintained that low risk profile over 5 years. For those with low risk profile, only older age (RR: 0.93) and low educational level (RR: 0.80) were significantly inversely associated with maintaining low risk profile. Conclusion: Low education level had an unfavorable impact on changes in risk profiles. This underscores the need to target preventive efforts at individuals with low education in the prevention of CVD. A healthy diet and physical activity were the only modifiable risk factors that were favorably associated with attaining low risk profile.