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BackgroundThe associations between individual cardiovascular disease risk factors and leukocyte telomere length (LTL) have been inconclusive. We investigated the association between LTL and overall cardiovascular health (CVH) as defined by the American Heart Association and whether the association is modified by sex and race/ethnicity. Methods and ResultsWe included 5194 adults (aged ≥20) from the National Health and Nutrition Examination Survey 1999–2002. CVH was defined as a composite score of the 7 metrics (smoking, physical activity, diet, body mass index, blood pressure, total cholesterol, and fasting blood glucose) and categorized as “poor,” “intermediate,” and “ideal.” LTL was assayed from whole blood using the quantitative polymerase chain reaction method relative to standard reference DNA. Multivariable linear regression models were used to estimate the association between CVH and log‐transformed LTL. We found strong graded association between CVH and LTL in the overall sample, with evidence of dose‐response relationship (P for trend=0.013). Individuals with poor and intermediate CVH had significantly shorter LTL than individuals with ideal CVH (−3.4% [95% CI=−6.0%, −0.8%] and −2.4% [−4.4%, −0.3%], respectively), after adjustment for demographic variables, socioeconomic status, and C‐reactive protein. The association was stronger in women (−6.6% [−10.2%, −2.9%] for poor vs ideal CVH) and non‐Hispanic whites (−4.3% [−7.1%, −1.4%] for poor vs ideal CVH). ConclusionsThe findings suggest that less‐than‐ideal CVH is associated with shorter LTL, but this association varies by sex and race/ethnicity. Future longitudinal research is needed to elucidate the mechanisms that underlie the association between CVH and LTL.