Background: The health benefits of regular physical activity are well documented. However, there are few studies associating this practice with sedentary behavior and cardiovascular risk in adolescents. Objectives: To evaluate physical activity levels and sedentary behavior and their associations with cardiovascular risk using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score Methods: A cross-sectional study carried out in state-owned public schools in Campina Grande, PB, Brazil, with 576 adolescents aged 15 to 19 years, investigating socioeconomic; demographic; lifestyle; and clinical variables. Data were collected using a validated form covering anthropometry data; blood pressure measurements; and laboratory tests. Data were analyzed using descriptive statistics, Pearson' s chi-square test, and binomial logistic regression using SPSS 22.0 and adopting a 95% confidence interval. Results: Mean age was 16.8 years.The majority of the adolescents were female (66.8%); non-white (78.7%); and belonged to socioeconomic classes C, D and E (69.1%). The prevalence rates of sedentary behavior and physical inactivity were 78.1% and 60.2%, respectively. According to the PDAY score, 10.4% of adolescents were at high cardiovascular risk and 31.8% and 57.8% were at intermediate risk and low risk, respectively. PDAY scores were associated with sex and abdominal adiposity. Conclusions: It was found that abdominal fat and being male were important cardiovascular risk factors in adolescents. Considering that modifiable risk factors were present, preventive measures aimed at lifestyle changes are essential.