ABSTRACT: Background Long-term risks of cardiovascular disease (CVD) according to levels of cardiovascular health (CVH) have not been characterized in a diverse, representative population. Methods and Results We pooled individual-level data from 30 447 participants (mean [SD] age, 55.0 [13.9] years; 60.6% women; 31.8% black) from 7 US cohort studies. We defined CVH based on levels of 7 American Heart Association health metrics, scored as ideal (2 points), intermediate (1 point), or poor (0 points). The total CVH score was used to quantify overall CVH as high (12-14 points), moderate (9-11 points), or low (0-8 points). We used a modified Kaplan-Meier analysis, accounting for the competing risk of death, to estimate the lifetime risk of CVD (composite of incident myocardial infarction, stroke, heart failure, or CVD death) separately in white and black men and women free of CVD at index ages of <40, 40 to 59, and ≥60 years. High CVH was more prevalent among women compared with men, white compared with black participants, and in younger compared with older participants. During 538 477 person-years of follow-up, we observed 6546 CVD events. In women aged 40 to 59 years, those with high CVH had lower lifetime risk (95% CI) of CVD (white women, 12.6% [2.6%-22.6%]; black women, 0.0%) compared with moderate (white women, 16.6% [13.0%-20.2%]; black women, 12.7% [6.8%-18.5%]) and low (white women, 33.8% [30.6%-37.1%]; black women, 34.7% [30.4%-39.0%]) CVH strata. Patterns were similar for men and individuals <40 and ≥60 years of age. Conclusions Higher baseline CVH at all ages in adulthood is associated with substantially lower lifetime risk for CVD compared with moderate and low CVH, in white and black men and women in the United States. Public health and healthcare efforts aimed at maintaining and restoring higher CVH throughout the life course could provide substantial benefits for the population burden of CVD.
