Firefighters perform strenuous work in dangerous and unpredictable environments requiring optimal physical conditioning. The aim of this study was to investigate the association between physical fitness and cardiovascular health (CVH) in firefighters. This cross-sectional study systematically recruited 309 full-time male and female firefighters between the ages of 20 to 65 years in Cape Town, South Africa. Physical fitness was assessed using absolute (abV̇O2max) and relative oxygen consumption (relVO2max), grip and leg strength, push-ups and sit-ups, sit-and-reach for flexibility and lean body mass (LBM). CVH encompassed age, smoking, blood pressure (BP), blood glucose, lipid profile, body mass index, body fat percentage (BF%), and waist circumference. Linear regressions and logistic regressions were applied. Multivariable analysis indicated that relVO2maxwas associated with systolic BP (p< 0.001), diastolic BP (p< 0.001), non-fasting blood glucose (p< 0.001), and total cholesterol (p= 0.037). Poor CVH index was negatively associated with relV̇O2max(p< 0.001), leg strength (p= 0.019), and push-ups (p= 0.012). Furthermore, age was inversely associated with V̇O2max(p< 0.001), push-up and sit-up capacity (p< 0.001), and sit-and-reach (p< 0.001). BF% was negatively associated with abV̇O2max(p< 0.001), grip and leg strength (p< 0.001), push-ups (p= 0.008), sit-ups (p< 0.001), and LBM (p< 0.001). Cardiorespiratory fitness, muscular strength, and muscular endurance were significantly associated with a better overall CVH profile.