Objective: To observe the prevalence and distribution of ideal cardiovascular health metrics in middle-aged men living in Su-Xi-Chang region and explore the relationship between health behavior and health factors. Methods: A total of 27 824 middle-aged men, who took part in health examination in the Center for Healthcare Management, Taihu Rehabilitation Hospital of Jiangsu Province from January 2014 to June 2015, were enrolled in this cross-sectional study. The ideal cardiovascular health metrics were defined by the American Heart Association criteria with minor modification in that the amount of vegetable intake was replaced by salt intake. The prevalence and distribution of ideal cardiovascular health metrics as well as the association between ideal cardiovascular health metrics and health factors were analyzed in this cohort. Results: The body mass index in the whole cohort was (25.1±3.0) kg/m2, waist circumference was (87.3±8.42) cm; the percent of subjects with all seven ideal cardiovascular health metrics was only 0.5% (n=133). The highest proportion of ideal metric was total cholesterol (68.5%, n=19 056), followed by fasting glucose (66.9%, n=18 616), body mass index (50.2%, n=13 963), physical exercise (45.6%, n=12 697), smoking (40.3%, n=11 216), blood pressure (22.5%, n=6 257) and salt intake (15.6%, n=4 351). The proportion of ideal cardiovascular health metrics reduced gradually and the proportion of poor cardiovascular health metrics status increased gradually with aging(χ2=106.746, P=0.000). The total cholesterol level of non-smokers was significantly lower than that of smokers(F=8.571, P=0.000); total cholesterol, blood pressure and fasting glucose levels increased in proportion with increasing body mass index(all P<0.01); total cholesterol and fasting blood glucose of subjects with regular active physical exercise were significantly lower than those with inactive physical exercise(all P<0.01); total cholesterol and blood pressure of subjects with high salt intake were significantly higher than those with low salt intake(all P<0.01). Conclusions: The proportion of subjects with ideal cardiovascular health metrics is very low in middle-aged men living in Su-Xi-Chang region, and the downtrend with poor cardiovascular health metrics increases with aging. Overweight or obese, smoking, high salt diet and poor control of blood pressure are the major cardiovascular risk factors in this cohort.