BACKGROUND: The development of consultations towards more patient centredness and shared decision making has greatly influenced general practice. Several patient-based studies have been published on shared decision making in screening and health checks. However, few studies have explored the process in-depth to understand perspectives of patients at high cardiovascular risk and their experiences of preventive consultations. AIM: To explore and analyse experiences of preventive consultations in patients at high cardiovascular risk. METHOD: Individual, semi-structured interviews with 12 patients at increased risk of cardiovascular disease (CVD) conducted within two weeks of a dedicated preventive consultation. Grounded theory was used in the analysis. RESULTS: The patients' experienced benefits from the consultation included changed emotions, thoughts, readiness to change lifestyle and perceived knowledge related to health and risk. Patients reported that their experienced benefits were related to the general practitioner's (GP's) professional competence, communication in the consultation and especially the doctor-patient relationship. Patients also expressed a number of unfulfilled expectations concerning their opportunities to contribute their personal perspectives to the consultation, short consultation duration, problems with appropriate timing and personal relevance of content and insufficient tailoring to their personal situation. GPs' communication skills and scheduling of follow-up consultations were reported by the patients as essential for these specific aspects to be addressed successfully. CONCLUSION: Patients reported a number of benefits from preventive consultations. However, their unfulfilled expectations suggest the benefits could be even greater, both with enhanced communication skills from doctors, and attention to appropriate timing of the consultations at stages of life when patients are more able to make changes.