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Objectivesto evaluate the association of sex-and-gender-specific cardiovascular disease risk factors, their prevalence, and correlates among adults in Sierra Leone.Study designThis community-based cross-sectional study used a stratified multistage random sampling.Methodsthe survey was conducted in eight (8) selected randomized sub-zonal communities across the western urban area in Sierra Leone, with an included sampling of 2394 adults. The WHO stepwise approach for non-communicable diseases was utilized. Multivariable logistic regression was done to determine associations between demographic characteristics and cardiovascular risk factors.ResultsThe prevalence of hypertension (33.4% vs 37.4%, p=0.068), diabetes mellitus (7.4% vs 9.2%, p=0.101), overweight (32.3% vs 34.2%, p=0.323) and obesity (9.9% vs 10.2%, p=0.818) were higher among males in comparison to females. Body Mass Index (BMI) (25.0 ± 5.0 vs 24.6 ± 4.4, p = 0.029), waist circumference (WC) (93.6 ± 4.5 vs 80.0 ± 5.0, p < 0.001), triglyceride (1.7±0.35 vs 1.6±0.32, p=0.013), total cholesterol (5.1±0.77 vs 4.9±0.66, p < 0.001) and low HDL-C (1.28 ± 0.29 vs 1.3±0.24, p = 0.016) were significantly higher among females as compared to males. The odds of having dyslipidemia [OR = 1.339; 95% C.I: (1.101-1.629), p=0.003] and consuming alcohol [OR = 1.229; 95% C.I: (1.026-1.472),p=0.025] were higher among females. Women had 1.8 times greater odds [AOR=1.849; 95% C.I: (0.713 - 1.010),p=0.030] of being hypertensive, 1.4 times greater odds [AOR=1.441; 95% C.I: (1.176 - 1.765),p=p=0.037] of consuming alcohol compared to men. BMI, WC, and raised blood sugar had a strong correlation among women than men.ConclusionBeing female was associated with a high prevalence of cardiovascular health risks in Sierra Leone. This study emphasizes the importance of reducing the CVD burden among females through policies related to public health education and screening strategies.