Finnish municipal employees in lower occupational classes showed 50% cardiovascular disease rates versus 46% in higher classes over two decades of follow-up. Insufficient physical activity emerged as the strongest predictor with a 44% increased hazard ratio, while smoking, poor diet, and heavy drinking also clustered in lower-income workers. Health behaviors collectively explained 40% of the excess cardiovascular risk associated with occupational class differences. The findings illuminate how workplace hierarchies translate into health disparities through behavioral pathways. Physical inactivity's outsized impact suggests targeted workplace wellness programs could meaningfully reduce class-based health inequities. Intriguingly, unhealthy diet showed stronger cardiovascular associations in higher occupational classes, possibly reflecting different dietary risk patterns across social strata. However, 60% of the occupational health gap remained unexplained, pointing to broader structural determinants like workplace stress, economic insecurity, and healthcare access. This preprint awaits peer review, so conclusions may shift with additional scrutiny. The large cohort and 20-year follow-up strengthen the findings, though generalizability beyond Finnish municipal workers requires validation. The research provides actionable evidence for workplace interventions while underscoring that individual behavior change alone cannot eliminate health inequalities.