Abstract Background Aim of the study was to assess trends of cardiovascular risk factors among Siberian adolescents during the last 30 years including period of Russian reforms (1989-2019). Methods Seven cross-sectional surveys of representative samples of school children aged 14-18 since 1989 (every 5 years) were carried out. Body mass index (BMI), systolic and diastolic blood pressure, serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured. Self-reported smoking and physical activity rates were obtained. To define overweight the sex- and age-specific IOTF cutoffs for BMI were used. Hypertension (HT) and lipid disorders were revealed according to international criteria. Results Prevalence of high TC significantly decreased from 22 to 4% (p < 0,01) in males and from 32 to 17% (p < 0,05) in females. High LDL-C showed similar trends. Prevalence of low HDL-C was stable with some fluctuations. In the period of Russian reforms (1989-1999) the prevalence of overweight significantly decreased from 12% in boys and from 14% in girls in 1989 to 4% in 1999 (p < 0,01). Since 2003 rapid increasing of overweight was observed. Trends of HT have shown double decreasing during the reform period and stabilization in the post-reform time. So, since 2003 discordant trends in HT and overweight were revealed. Physical activity was stably low in boys (49-55%) and girls (83-73%). Average weekly screen time doubled from 15 (2009) to 30 h/w (2019), p < 0,05. Cigarette smoking rates in boys dramatically decreased from 45% (1989) to 3% (2019), in girls - from 19% to 5% (p < 0,01). Smoking of electronic devices was registered in 2019: 6% among boys and 3% among girls. Conclusions Obtained data indicate on trends to reduction in CVD risk profile among Siberian adolescents during the period of Russian reforms. Discordant trends of HT and overweight were revealed. The study was supported by RFBR grant 19-013-00800. Key messages Long time changes in cardiovascular risk profile among Siberian adolescents were registered. Against the background of a decrease in combustible smoking among adolescents, electronic smoking began to register.