Introduction: The aim of this study is to describe trends in modifiable vascular risk factors and coronary mortality between 1986 and 2013 among residents of the Lille metropolitan area aged 40 to 64 years. Methods: Data were drawn from four cross-sectional surveys and the Lille Ischemic Heart Disease Registry. The risk of coronary death was estimated using the coronary component of the SCORE tool based on risk factors measured in the population. The results were adjusted for age, and their trends were analyzed using logistic regression or multiple linear regression. Results: The prevalence of hypertension and dyslipidemia decreased significantly in the Lille metropolitan area between 1986 and 2013. The prevalence of diabetes decreased significantly among women but remained stable among men. The prevalence of overweight and obesity increased among men and remained stable among women. The prevalence of current smoking decreased among men but remained stable among women. The risk of coronary death estimated by SCORE decreased significantly. Over the same period, coronary mortality decreased slightly faster than the risk estimated by SCORE. Conclusion: Between 1986 and 2013, the prevalence of the main vascular risk factors decreased or remained stable among residents of the Lille metropolitan area aged 40 to 64, with the exception of the prevalence of overweight and obesity, which increased among men. Coronary mortality decreased over this period.