Objective To explore the status quo and influencing factors for health-promoting lifestyle in the rural populace with high risk of cardiovascular and cerebrovascular diseases, and to provide reference for developing primary prevention strategies for cardiovascular and cerebrovascular diseases. Method Questionnaire-based survey of 585 cases of high-risk cardiovascular and cerebrovascular population in 11 administrative villages in Fuling of Lishui city was conducted using the Health Promoting Lifestyle Profile-II (HPLP II), Perceived Social Support from Family Scale (PSS-Fa), General Health Questionnaire (GHQ-12), and other questionnaire tools. Results The total score of the health-promoting lifestyle in the rural populace with high risk of cardiovascular disease is 125.55 ± 20.50, which is at an average level, and the mean scores of each dimension in descending order are—nutrition, interpersonal support, self-actualization, stress management, health responsibility, and exercise. Monofactor analysis revealed that age, education level, marriage, monthly per capita household income, physical activity based on the International Physical Activity Questionnaire (IPAQ), family support function, carotid intima-media thickness, and blood pressure were influencing factors for the health-promoting lifestyle in the rural populace with high risk of cardiovascular and cerebrovascular diseases (P < 0.05). Multiple stepwise regression analysis showed that monthly per capita household income, family support function, physical activity based on the IPAQ, and education level were positively correlated with the level of the health-promoting lifestyle. Conclusion The health-promoting lifestyle level of the rural populace with high risk of cardiovascular and cerebrovascular diseases needs to be improved. When assisting patients to improve their health-promoting lifestyle level, it is imperative to pay attention to improving patients' physical activity level, emphasizing the influence of the family environment on patients, and focusing on patients with economic difficulties and low education level.