Abstract: Objective To investigate the associations of cardiometabolic risk factors with cardiovascular disease morbidity and mortality and to quantify the population attributable fraction. Methods This study was based on Prospective Urban Rural Epidemiology-China (PURE-China), a large cohort study involving subjects aged 35-70 years from 115 urban and rural communities in 12 provinces of China. The subjects were recruited from 2005 to 2009 and followed up once every three years. The follow-up time of this analysis ended in April 2021. The associations of cardiometabolic risk factors (hypertension, diabetes, dyslipidemia, and abdominal obesity) with cardiovascular disease morbidity and mortality were evaluated using multifactorial Cox fragility model, and the attributable burden of cardiovascular disease was explored by calculating the population-attributable risk score. Results The mean age of the cohort (39 693 participants) was (50.41±9.62) years. After a median follow-up of 11.9 years, 2 086 (5.3%) all-cause deaths and 688 (1.7%) cardiovascular deaths as well as 3 112 (7.8%) cardiovascular events were recorded. Multifactorial Cox fragility modeling revealed that diabetes and hypertension were the two most important metabolic risk factors, the hazard ratio (HR) of diabetes was 1.665 95%confidential interval (CI): 1.459-1.899, P<0.001 for all-cause mortality, and the HRs of hypertension were 2.388 (95% CI: 2.002-2.849, P<0.001) for cardiovascular disease mortality and 1.983(95% CI: 1.833-2.146, P<0.001) for cardiovascular disease morbidity. In addition,18.2% of all-cause and 49.7% of cardiovascular mortality, and 42.0% of cardiovascular events were attributed to the effect of cardiometabolic risk factors. Among all metabolic risk factors, hypertension contributed the most, explaining 13.3%, 36.1% and 28.6% of all-cause deaths, cardiovascular diseases and cardiovascular events respectively. Conclusion Cardiometabolic risk factors are associated with increased risk of cardiovascular events and death, highlighting the importance of comprehensive management for hypertension, diabetes and dyslipidemia in the prevention of cardiovascular diseases.