Strategic risk management impacts organizations’ competitive advantage; it is an opportunity for growth, anticipation, and sustainability. Small and medium-sized enterprises (SMEs) are significantly exposed to these risks and are a fundamental part of the current business fabric. This research aims to analyze the management of strategic risks for the sustainability of SMEs in the manufacturing sector in Antioquia. A qualitative methodology was used for the development, and ten semi-structured interviews were conducted with managers of the selected SMEs. The results show that strategic risk management contributes to the sustainability of SMEs across economic, social, and environmental pillars. The strategic risks most frequently mentioned as priorities for sustainability include long-term risks associated with strategy formulation and definition, as well as the value proposition. Additionally, the risk of human talent management, which is present in all analyzed organizations, was highlighted. Based on the research, interested organizations can be recommended to implement processes and practices associated with strategic risk management for sustainability. The research presents a significant novelty by specifically addressing the management of strategic risks for the sustainability of SMEs in the manufacturing sector. Unlike previous research, our study focuses on the specific risk management practices of SMEs in this geographical context, adding an important regional and sectoral dimension to the field of study.