Abstract Introduction: Cardiovascular diseases (CVDs) are primarily driven by modifiable behavioural risk factors and are the leading cause of death globally. In low- and middle-income countries (LMICs), rapid urbanization and changes in behaviour are exacerbating the burden of CVDs but there is limited research into specific associations with CVDs in older adults in low-income countries, such as Sierra Leone. This study examines the association between behavioural risk factors and their physiological sequalae among adults aged 40 and above in Bo District, Sierra Leone. Methods: A cross-sectional study design was used to collect data from 1,978 randomly sampled adults through a household survey. Survey questions were based on the validated WHO STEPs questionnaire. Multivariable logistic regression analysis was performed to determine the associations between behavioural risk factors (such as diet, physical activity, and salt intake) and the presence of hypertension, diabetes, and obesity, adjusting for socio-demographic variables. Results: At least one physiological risk-factor for CVD was present in 43.5% of participants. Hypertension was associated with urban living (OR=1.46, 95% CI [1.41-1.51]), older age (OR for 80+=3.98, 95% CI [3.70-4.28]), insufficient fruit and vegetable intake (OR=1.52, 95% CI [1.46-1.60]), and low physical activity (OR=1.35, 95% CI [1.27-1.43]). Diabetes was associated with urban residence (OR=1.84, 95% CI [1.66-2.05]), older age (OR for 70-79 =3.82, 95% CI [3.28-4.45]), low fruit and vegetable consumption (OR=1.61, 95% CI [1.36-1.90]), high salt intake (OR=1.34, 95% CI [1.21-1.49]), and low physical activity (OR=1.47, 95% CI [1.26-1.71]). Obesity was less likely among males (OR=0.37, 95% CI [0.36-0.38]) and those aged 80+ (OR=0.39, 95% CI [0.35-0.43]). Conclusion: This study highlights the need for evidence for targeted public health interventions in Bo District, Sierra Leone. Promoting healthier lifestyles to reduce poor diet, and physical inactivity, particularly in urban areas, could decrease CVD prevalence. Keywords: Cardiovascular diseases, Diet, Physical inactivity, Sierra Leone, Public health interventions

The authors have declared no competing interest.

This study was funded by small grant from wellcome-trust,UK. grant number - 209921/Z/17/Z

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Ethics Committee of Sierra Leone Ethics and Scientific Review Committee (SLESRC) at the Ministry of Health and Sanitation (MoHS) and Kings College London (HR-17/18 7298) gave full ethical approval for this work.

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