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Presenteesim, as well as medical/pharmaceutical costs, have attracted attention in the occupational health field in Japan. Presenteeism and health risks are known to be associated. However, the relationship between health risks and total burden of presenteeism, absenteeism, and medical/pharmaceutical cost have only received scarce attention. We aimed to investigate this relationship by examining the data of Japanese workers.We conducted this study using the data of >40 year-old workers obtained from four pharmaceutical companies and health insurance associations. The workers were classified into three categories (low-risk, middle-risk, and high-risk) according to probabilities of developing cardiovascular disease, as calculated by risk factors (e.g., smoking, alcohol intake, and Body Mass Index) obtained from a previous study. Health data from self-administered questionnaires completed by the workers in 2014 were collected to evaluate presenteeism, and from compensation claims from the health insurance associations to calculate medical/drug costs. To measure presenteeism, we used the QQ method. We received medical (in-/out-patient) and drug (out-patient) data of all study samples from April 2014 to March 2015.The total sample in the final analysis numbered 7808 (low-risk: 2755, middle-risk: 2672, and high-risk: 2381). The total cost for the high-risk group was the highest of all three groups (€4,138/year/person), followed by the middle-risk group (€4,068/year/person), then the low-risk group (€3,620/year/person). Presenteeism was the largest cost in all groups, with the cost being the highest for the middle-risk group among all three groups.Many interventions have been conducted for high-risk workers in Japan, but ones for low- and middle-risk workers remain insufficient. Our findings suggest that greater awareness is needed about the intervention needs of low- and middle-risk workers, especially with regard to presenteeism. To increase this awareness, we plan to proceed with further study and make a detailed proposal.