Well-Being Longevity

Most Americans have poor cardiometabolic health

“These numbers are striking. It’s deeply problematic that in the United States, one of the wealthiest nations in the world, fewer than 1 in 15 adults have optimal cardiometabolic health.”

Story at a glance

  • Researchers evaluated Americans across five health factors, including blood pressure, blood sugar, blood cholesterol, adiposity and weight, as well as whether they had heart related disease. 

  •  They found only 6.8 percent had excellent levels across the five indicators.

  • For the study, researchers looked at a nationally representative sample of around 55,000 people older than 20 from 1999 to 2018, focusing on the five components of health instead of the presence of disease.   

Fewer than 7 percent of Americans are in optimal cardiometabolic health, according to new research.  

Tufts University researchers evaluated Americans across five components of health, including blood pressure, blood sugar, blood cholesterol, adiposity and weight, and whether they had heart related disease. They found only 6.8 percent had excellent levels across the five indicators.  

“These numbers are striking. It’s deeply problematic that in the United States, one of the wealthiest nations in the world, fewer than 1 in 15 adults have optimal cardiometabolic health,” said the study’s lead author Meghan O’Hearn 

“We need a complete overhaul of our healthcare system, food system, and built environment, because this is a crisis for everyone, not just one segment of the population.” 

For the study, researchers looked at a nationally representative sample of around 55,000 people older than 20 from 1999 to 2018, focusing on the five components of health instead of the presence of disease. 

“We don’t just want to be free of disease,” O’Hearn continued. “We want to achieve optimal health and well-being.” 

The team also found several key differences in health along socioeconomic, racial and gender lines. Researchers noted, for example, between 1999 and 2018 cardiometabolic health declined for Mexican Americans, other Hispanics and non-Hispanic Black Americans while increasing slightly among non-Hispanic white Americans.  

“This is really problematic. Social determinants of health such as food and nutrition security, social and community context, economic stability, and structural racism put individuals of different education levels, races, and ethnicities at an increased risk of health issues,” the study’s senior author Dariush Mozaffarian said.  

“This highlights the other important work going on across the Friedman School and Tufts University to better understand and address the underlying causes of poor nutrition and health disparities in the U.S. and around the world.” 

O’Hearn added that addressing this health crisis will require multiple sectors coming together to form solutions alongside the political will to enact changes.  

“This is a health crisis we’ve been facing for a while,” O’Hearn said. “Now there’s a growing economic, social and ethical imperative to give this problem significantly more attention than it has been getting.” 


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A separate study, using the American Heart Association’s new Life Essential 8 metrics, found that only 1 in 5 Americans have ideal heart health. The measurements of heart health included diet, physical activity, nicotine exposure, sleep duration, body mass index, blood lipids, blood glucose and blood pressure to determine an adult’s overall cardiovascular health.    

An adult’s cardiovascular score — ranging from 1 to 100 — is calculated by adding together totals for the eight metrics then dividing by eight. Scores below 50 indicate poor heart health, while scores between 50 and 79 mean a person is considered in moderate cardiovascular health. The remainder are classified as being in optimal health. 

One study used data from the disease from the U.S. National Health and Nutrition Examination surveys in 2013-18 to measure the heart health of more than 23,400 U.S. adults and children free of cardiovascular disease. It found that 80 percent of U.S. adults fell into the poor or moderate categories.   

The average health score for both adults and children were below 66. Close to 20 percent of U.S. adults had high cardiovascular health; 62.5 percent were classified as moderate. 

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