Patients with rheumatoid arthritis (RA) are characterized by reduced physical activity and increased morbidity and mortality from cardiovascular disease (CVD). The aim of this study was to investigate associations between levels of physical activity and CVD risk profile in RA patients. Levels of physical activity were assessed in 65 RA patients (43 females). Using the International Physical Activity Questionnaire, patients were allocated into three groups: active, moderately active and inactive. Anthropometric characteristics, RA activity/severity, multiple classical and novel CVD risk factors and 10-year CVD event probability were assessed and compared among the three groups. Significant differences were detected among groups in systolic blood pressure (P = 0.006), cholesterol (P < 0.001), low-density lipoprotein (P = 0.01), homeostasis model assessment (P = 0.001), type-1 plasminogen activator inhibitor antigen (P < 0.001), tissue-type plasminogen activator antigen (P = 0.019), homocysteine (P = 0.027), fibrinogen (P = 0.001), apolipoprotein B (P = 0.002) and von Willebrand Factor (P = 0.001), with a consistent deterioration from the physically active to the physically inactive group. Multivariate analysis of variance revealed that levels of physical activity were significantly associated with the differences in all of the above variables (P < 0.05) after adjustment for age, weight, sex, smoking status, as well as RA disease activity and severity. This cross-sectional study suggests that physically inactive RA patients have significantly worse CVD risk profile compared with physically active patients. The possible beneficial impact of increased physical activity, including structured exercise, to the CVD risk of RA patients needs to be accurately assessed in prospective studies.