Background: Cardiovascular prevention can be provided to patients at different risk levels. The aim of this study was to compare the quality of cardiovascular prevention provided in European primary care between patients with diagnosed coronary heart disease (CHD) and individuals at high risk due to known risk factors but not labelled with a diagnosis of cardiovascular disease (CVD). Additionally, we aimed to identify individual and practice factors to predict risk factor control. Methods: An international cross-sectional study was conducted in 10 European countries. Clinical record data were abstracted for quality indicators for 8928 patients in 10 countries and patient questionnaires were completed by 7846 patients in nine countries. Information about 320 general practices was assessed using practice questionnaires and interviews. Hierarchical multilevel modelling was used for analyses. Results: Recording of risk factors and advice was higher in the CHD than in the high-risk group. Risk factor control was better in the CHD group: uncontrolled levels of blood pressure (34.2 vs. 49.3%; p<0.001), cholesterol (32.4 vs. 64.5%; p<0.001). Predictors of risk factor control were medication adherence (RR 0.97; p=0.007) and health-related quality of life (RR 0.86; p=0.005). Being at high risk (RR 1.42; p<0.001), being single (RR 1.12; p<0.001), and having lower educational level (RR 1.09; p<0.001) were associated with poorer risk factor control. Practice factors were not associated with outcomes. Conclusions: Strategies to improve guidelines adherence in cardiovascular prevention may be stronger focused on individuals at risk before CVD is diagnosed and require organizational and political support to reinforce general practices.