The rising prevalence of cardiovascular diseases (CVD) remains a global concern. In Nigeria, the current prevalence of CVD was 76.11% with its attendance burden. The CVD risk perception of individuals is a precursor to the desired lifestyle modification necessary for CVD prevention and management. This study assessed the CVD risk perception and sociodemographic determinants among rural and urban dwellers in southwest Nigeria. The study employed a convergent parallel mixed-methods design involving concurrent data collection. The participants' CVD risk perception was obtained using the Perception of Risk of Heart Disease Scale (quantitative data) and a validated focus group discussion (FGD) guide (qualitative data). Quantitative analysis was completed using descriptive statistics, Phi, Cramer's V, and multivariate linear regression, while the FGD was thematically analysed. The quantitative study involved 1,493 participants (62.4% women) with a mean age of 46.90±15.65 years, while the FGD involved 53 participants (52.8% women) with a mean age of 50.10±13.5 years. Over a quarter (28%) of the participants had a poor CVD risk perception; the mean score was 44.40±8.07. Rural residents had a significantly poorer CVD risk perception than their urban counterparts (Mean difference = -3.16, p<0.001). Having tertiary education (β = 0.100, p < 0.001), living in urban areas (β = 0.174, p<0.001), and living in Lagos (β = 0.074, p = 0.013) and in Oyo, other than Ogun state (β = -0.156, p<0.001) significantly predicted having a good perception of CVD risk. FGD produced three themes: knowledge about CVD, CVD risk factors, and CVD prevention. Participants had a fair understanding of the causes and prevention of CVD. Yet, a substantial portion underestimated their own risk of developing CVD, particularly rural dwellers and people with lower education. More public health education is required to improve the CVD risk perception in southwestern Nigeria.
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