Introduction Healthier lifestyle behaviours might be related to a lower cardiometabolic risk predisposed by menopause transition. The objectives of the study were: 1) to examine the association of sedentary time (ST) and physical fitness with “Ideal Cardiovascular Health” (ICH) in perimenopausal women, and 2) to determine the capacity of ST and physical fitness tests to discriminate between the presence or absence of ICH status in this population. Study design Observational cross-sectional study. Main outcome measures Sedentary time and different levels of physical activity were objectively assessed using triaxial accelerometry (on 7 consecutive days). Physical fitness was assessed with the Senior Fitness Test battery, handgrip strength, and sit-and-reach tests. ICH status was created from the cut-off values of several health behaviours (smoking, body mass index, physical activity, and diet) and classical cardiometabolic markers (plasma total cholesterol and fasting glucose, and blood pressure). Results A total of 122 perimenopausal women (52.6 ± 4.2 years old) participated in this study. After adjusting for covariates, perimenopausal women with ICH status spent less time in sedentary behaviours and had higher scores on the 6-min-walk, 30-s-chair-stand, and back-scratch tests than women with a non-ICH status (all, P≤.03). Cut-off values of <460 min/day in ST and ≥−3 cm on the back-scratch test were associated with around threefold higher odds (95% confidence interval 0.14-0.71 and 1.47–7.01, respectively, all P <.01) of having ICH status. Conclusion Reduced ST and greater cardiorespiratory fitness, upper-body flexibility, and lower-body muscular strength were associated with a better cardiovascular profile in perimenopausal women. Including ST and upper-body flexibility as complementary ICH metrics might facilitate early identification of perimenopausal women with a higher risk of cardiovascular disease. However, further studies evaluating the usefulness of these potential complementary diagnostic tools in perimenopausal women are warranted before they are implemented in clinical practice.