Purpose. To assess the prevalence and contribution of biological, behavioral and socio-psychological factors among residents of the Tver region to the formation of cardiovascular risk (CVR). Materials and methods. A systematic analysis of official statistics (2018–2024) and a cross-sectional survey of 1,909 residents (938 men, 971 women) were performed: clinical and laboratory parameters, anxiety/depression questionnaires (Spielberger–Khanin, HADS), and calculation of relative CVR, SCORE and 10-year Framingham risk. Descriptive statistics, the Mann–Whitney U test/χ², Spearman correlation and multivariable regression (OR, 95% CI) were used. Results. In 2019–2023, the region recorded higher than the national average mortality and morbidity from circulatory system diseases; in 2023, mortality from CVD was 850 per 100,000 population. Among the examined participants, normal BMI was found in 33.2%; overweight in 32.1%, and grade I–II obesity was more common in men. Smoking prevalence was 41.4% in men and 32.0% in women; 15.2% engaged in regular physical activity. Women showed higher reactive anxiety and more frequent household stress, while men more often reported occupational stress 2–3 times per week. Men were more likely to fall into high relative CVR categories (4–5 points: 27.3% vs 13.6% in women); SCORE ≥5% was observed in 11.1% of men and 4.0% of women. In the multivariable model, age, BMI, smoking, low physical activity, elevated blood pressure, low HDL cholesterol, hyperglycemia and elevated CRP were significant predictors of relative CVR; for SCORE, occupational stress, anxiety and depression were additionally significant. Conclusions. CVR formation is multifactorial, combining traditional biomedical factors with behavioral and psychoemotional determinants. A multidisciplinary prevention approach is needed, with emphasis on weight control, smoking cessation, increased physical activity, and screening/correction of anxiety-depressive disorders.