Objective: To measure the differences in the recording of risk factors and lifestyle advice between those at high risk of cardiovascular disease and those diagnosed with cardiovascular disease, and to identify the practice characteristics associated with such recording in rural primary care. Design: A cross-sectional observation study of 14 general practices. Medical records were audited to measure recording of risk factors and lifestyle advice for those at high risk of and those diagnosed with cardiovascular disease. Practice characteristics were collected, with logistic regression used to test for an association with the recording of risk factors. Setting: General practices in rural Australia. Participants: Each practice was asked to identify 20 patients; 10 at high risk and 10 diagnosed with cardiovascular disease. Main outcome measures: The recording of risk factors and lifestyle advice in patient records and practice characteristics. Results: 282 records were audited with 142 being high risk and 140 diagnosed with cardiovascular disease.Measures recorded significantly less in the high-risk group were: blood pressure (94% versus 99%; P=0.019); physical activity (24% versus 56%; P=0.000); dietary advice (32% versus 51%; P=0.001); and physical activity advice (34% versus 56%; P=0.000). Recording of risk factors was positively associated with practice involvement in quality improvement (P<0.001), continuing education (P<0.001), and greater percentage of general practitioners (P<0.05) and practice nurses (P<0.001). Conclusions: There is substantial room for enhanced cardiovascular disease prevention through rural primary care in Australia, particularly for high-risk patients. This study has demonstrated an association between practice factors (including targeted education, quality improvement activities and appropriate workforce) and improved preventive activities.