We assessed prevalence of cardiovascular risk factors, ischaemic heart disease (IHD) and unhealthy lifestyles in 3723 participants aged ≥ 25 years in the northern Persian Gulf region; 96.0% had ≥ 1 cardiovascular risk factor. Over 60% had unhealthy body weight, only 8.3% ate the recommended amount of fruits and vegetables, 70.6% were physically inactive and 19.0% were current smokers. Prevalence of electrocardiogram (ECG) with evidence of IHD was 12.7%. Present or past smoking and truncal obesity were independently associated with IHD ECGs in men, and past or present smoking and obesity in women. Hypertension and diabetes were independently associated with increased risk of IHD ECG.