Background <p>Ethnically diverse populations can present variations in cardiovascular risk, which can be influenced by differences in lipid profiles and other cardiovascular risk factors. This study aimed to evaluate lipid profiles and traditional cardiovascular risk factors in a Mediterranean population, with a focus on variations by ethnicity and sex.</p> Methods <p>We conducted a population-based cross-sectional study using the “Information System for the Development of Research in Primary Care” (SIDIAP) database, which includes primary care data from Catalonia, Spain, collected between 2015 and 2019. The study included subjects aged 40 to 89 years with no prior history of cardiovascular disease (CVD) or lipid-lowering therapy. Descriptive analyses were performed to compare lipid profiles and traditional risk factors across ethnic groups and sex.</p> Results <p>We included 806,458 participants, 56.8% women, 89.9% from Southern Europe, 5.3% from Latin America and Caribbean origin, 3% from North Africa, 0.8% from Central/South Africa and 1% from Asia. Asian individuals presented the most atherogenic lipid profile, with the lower HDL-C, higher triglyceride levels, and elevated atherogenic indices. Higher LDL-C values were observed in Latin American men and Southern European women. Among the groups studied, Central and South Africans presented the most favorable lipid profiles, with low triglyceride and atherogenic indices, regardless of sex. North Africans and Latin Americans presented higher obesity rates, whilst southern Europeans presented the highest prevalence rates of hypertension and smoking.</p> Conclusions <p>Individuals from Asia have worse lipid and metabolic profile compared with Central and South African individuals, regardless of sex. Current risk assessment tools may underestimate the cardiovascular risk in these specific populations.</p> Graphical abstract <p></p>