Objective 　To analyze the regional distribution and aggregation of risk factors for cardiovascular disease (CVD) among active China civil aviation pilots aged 40–59 years. Methods 　In 2011, 831 active pilots aged 40–59 years in Northern, Eastern and Southern China were investigated for risk factors of CVD. The regional distribution and aggregation of risk factors were analyzed. Results 　The mean hemoglobin A1c (HbA1c), mean total cholesterol (TC) and age standardized prevalence rate of high TC in Northern China (5.7%±0.5%, 5.6±1.1mmol/L and 23.6%, respectively) were significantly higher than in Eastern and Southern China. High density lipoprotein cholesterol (HDL-C), 1ow density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) were controlled poorer (1.1±0.2mmol/L, 3.6±0.7mmol/L and 125.7±9.4mmHg, respectively) in pilots from Eastern China, and their age standardized prevalence rates of low HDL -C and high LDL -C were 37.9% and 24.6%, respectively, which was obviously higher than that in pilots from other two regions. The mean fast plasma glucose (FPG, 5.5±0.5mmol/L) was significantly higher in pilots from Southern China than that in pilots from the other two regions. There was significant difference of 1 and 2 categories of risk factors for CVD among the three regions, and among 1, 2 and ≥3 kinds of CVD risk factors, combination of overweight and obesity, low HDL-C+ overweight and obesity, and high TG+ low HDL-C+ overweight and obesity ranked highest. Conclusions 　The regional distribution and aggregation of risk factors for CVD among active pilots aged 40–59 years old are significantly different. Prevention and control measures should be different among these three regions. Weight control is imperative for active pilots aged 40–59 years old. DOI: 10.11855/j.issn.0577-7402.2016.02.16