Lacustrine ecosystems have not been widely assessed for heavy metal contamination and associated health risks; yet, they could be accumulating these contaminants to the detriment of aquatic organisms and communities relying on them for various aspects. The water quality index (WQI) and concentrations of heavy metals including As, Cd, Co, Cu, Cr, Fe, Mn, Ni, Pb, and Zn in water, sediment, Oreochromis niloticus, and in the endemic and endangered Coptodon kottae in Lake Barombi Kotto in Cameroon were determined to evaluate fish heavy metal bioaccumulation, and heavy metal exposure risk posed to communities consuming these fish species. The WQI of the lake was found to be excellent with heavy metal concentrations that were lower than what was obtained in the sediments and fish samples. Mean heavy metal concentrations in sediment ranged from 0.86 ± 0.03 mg/kg for Cd to 560.1 ± 11.15 mg/kg for Fe. In both fish species, Fe, Mn, and Cu had the highest concentrations. Though the heavy metal concentrations in the lake water were low, heavy metal bioconcentration factors for both fish species were very high ranging from 1.6 for Fe to 1568 for Mn. The concentration patterns of heavy metals in the organs of both fish species followed the order bones > gut > muscle. Consumption of these two fish species contributes less than 1.0% of the permissible tolerable daily intake (PTDI) and provisional tolerable weekly intake (PTWI) of these metals with lead (Pb) having the potential to exceed permissible exposure levels when high amounts of these fish are consumed by adults.