Non-communicable diseases, particularly cardiovascular diseases (CVD) and metabolic syndrome (MS), remain a major challenge for primary health care (PHC). This study aimed to assess cardiometabolic risk and health behaviours in adult PHC patients using routine preventive screening. This prospective observational study included 506 adults attending routine consultations in an urban PHC centre in Poland. Preventive assessment included anthropometric measurements (body weight, height, BMI, and waist circumference), blood pressure, lipid profile, and fasting glucose levels. Health behaviours were recorded using the standardised NFZ CHUK questionnaire. The 10-year CVD risk was estimated using the SCORE2 algorithm. Multivariable logistic regression was used to identify independent factors associated with high cardiovascular risk (SCORE2 ≥ 5%) and of a composite endpoint defined as the presence of any non-optimal biochemical parameter. Nearly half of the participants had excess body weight (overweight or obesity), and more than half met criteria for central obesity. Borderline or elevated total cholesterol was found in 47% of patients, abnormal LDL in 27%, low HDL-C (<40 mg/dL) in 80% (84% when applying sex-specific cut-offs), and impaired fasting glucose or diabetes in about 12%. High SCORE2 risk (≥5%) was observed in approximately 9% of the cohort. In multivariable models, SCORE2 components (age, sex, and smoking) were, as expected, associated with high SCORE2 risk, and obesity (BMI ≥ 30 kg/m2)—a factor not included in SCORE2—was additionally associated with higher risk. Additionally, age, male sex, and obesity also predicted the presence of at least one non-optimal biochemical marker. The prevalence of high SCORE2 risk increased from 1.2% in patients with 0–1 modifiable risk factor to 25.7% in those with 4–5 factors. Lower educational attainment was associated with a higher proportion of high-risk individuals in univariate analysis. Routine preventive activities in PHC enable the identification of important lipid and glucose abnormalities and the clustering of modifiable risk factors, even in a relatively young, highly educated population. Systematic cardiovascular screening and a focus on patients with accumulated risk factors should remain a priority in PHC to enable early identification of high-risk patients and timely implementation of lifestyle and therapeutic interventions.