Here’s a sobering thought: if you gathered 15 random adults in the United States into a room,
odds are only one of them would have truly good cardiometabolic health. Everyone else would be
living with some combination of high blood pressure, excess weight, elevated blood sugar, or
abnormal cholesteroland sometimes all of the above.
That isn’t a dramatic headline; it reflects national data. A major analysis of U.S. adults found
that only about 6.8% had optimal cardiometabolic health as of 2017–2018, meaning fewer
than 1 in 14 people met healthy targets for weight, blood pressure, blood sugar, blood lipids,
and cardiovascular disease history.
The good news? Cardiometabolic health is not some mysterious lottery prize. It’s a combination
of risk factors we can measure, understand, andvery oftenimprove. The bad news is that we’re
not doing a great job of that as a country. Let’s unpack what “cardiometabolic health” really
means, how we got into this mess, and what you can actually do about it (ideally without turning
your entire life upside down).
What Exactly Is Cardiometabolic Health?
Cardiometabolic health brings together two big ideas:
cardio (your heart and blood vessels) and metabolic (how your body processes
energy, sugar, and fats). Instead of looking at just one numberlike blood pressure or weightit
looks at a whole package of risk factors that travel in a pack.
Many experts use the concept of metabolic syndrome or cardiometabolic syndrome to
describe this cluster. Typically, you’re considered to have metabolic syndrome if you have three
or more of the following: central obesity (extra fat around your waist), high blood pressure,
elevated fasting blood sugar, high triglycerides, and low HDL (“good”) cholesterol.
When these show up together, your risk of type 2 diabetes, heart attack, stroke, heart failure,
and even premature death climbs dramatically. So cardiometabolic health is basically:
“How many of these big-ticket risk factors do you haveand how well controlled are they?”
The Five Core Pieces Researchers Look At
- Body weight and waist size: Are you in a healthy range, or in overweight/obesity territory?
- Blood pressure: Is your blood pressure consistently below 120/80 mm Hg without medication?
- Blood sugar: Are your fasting glucose and A1C in the normal range (no diabetes or prediabetes)?
- Blood lipids: Healthy levels of LDL (“bad”) cholesterol, HDL (“good”) cholesterol, and triglycerides.
- History of cardiovascular disease: Have you had a heart attack, stroke, or other major heart condition?
In the Tufts-led analysis of U.S. adults, “optimal” cardiometabolic health meant hitting healthy
ranges for all of those factorsand not having cardiovascular disease. Only a tiny minority
cleared that bar.
How Did We End Up With Such Poor Cardiometabolic Health?
Short answer: it’s not just one thing. It’s the food environment, social factors, stress,
sleep, and our love affair with sitting. Let’s walk through some of the biggest drivers.
1. High Rates of Obesity and Overweight
Obesity is one of the core drivers of poor cardiometabolic health. Recent CDC data show that
about 40% of U.S. adults are living with obesity, with even higher rates in some regions and
demographic groups. When you include people who are “just” overweight,
roughly three-quarters of adults have excess body weight.
Extra weightespecially around the waistdisrupts insulin sensitivity, raises blood pressure,
and alters lipid levels. That’s basically a cardiometabolic triple-threat.
2. Diabetes and Prediabetes Are Common
According to the CDC, about 38.4 million people in the U.S. (around 11.6% of the population) are
living with diabetes, and millions more have prediabetes. Many don’t even know they
have it. Chronically elevated blood sugar quietly damages blood vessels, nerves, and organs,
and it strongly increases the risk of heart attack and stroke.
3. Multiple Chronic Conditions Are the Norm, Not the Exception
If you feel like everyone you know has “something” going on with their health, you’re not
imagining it. A recent analysis found that in 2023, about 76.4% of U.S. adults had at least one
chronic condition, and more than half had multiple chronic conditions. Many of those
conditionslike hypertension, diabetes, and high cholesterolare core cardiometabolic risks.
4. Lifestyle Patterns That Don’t Help Our Hearts
The American Heart Association (AHA) updated its famous “Life’s Simple 7” to
Life’s Essential 8, a checklist of eight behaviors and health factors that support good
cardiovascular and cardiometabolic health: diet, physical activity, nicotine exposure, sleep,
body mass index, blood lipids, blood glucose, and blood pressure.
The problem? As a country, we score pretty poorly. Ultra-processed foods make up a large share
of the American diet, a big portion of adults fall short of physical activity guidelines, many
people sleep less than 7 hours a night, and nicotine exposure (including vaping) is still common.
All of that chips away at cardiometabolic health over time.
5. Structural and Social Factors
Cardiometabolic health is not just about willpower. The Tufts analysis showed major disparities
by age, income, education, and race/ethnicity. People in communities with less access to
healthy food, safe places to exercise, primary care, and preventive services are more likely to
develop cardiometabolic problems and less likely to have them well controlled.
Why Good Cardiometabolic Health Matters So Much
This isn’t just about numbers on a chart. Cardiometabolic risk factors are tightly linked with
the leading causes of death in the United States. Cardiovascular disease remains the number one
killer, causing more than 940,000 deaths in 2022 alone, and nearly half of U.S. adults have some
form of cardiovascular disease.
Studies using the Life’s Essential 8 score have shown that people with higher scores (meaning
better overall cardiovascular and metabolic health) have significantly lower risks of heart
disease, stroke, heart failure, and death. In some analyses, each 10-point increase in the
overall score is linked with a 22–40% lower risk of cardiovascular events.
Translation: improving your cardiometabolic health isn’t a “nice-to-have” wellness goalit’s one
of the most powerful things you can do to live longer, feel better, and stay out of the hospital.
How to Improve Your Cardiometabolic Health (Without Being Perfect)
The idea of “optimal cardiometabolic health” can sound intimidating, like you need to become
a salad-munching marathon runner who never eats dessert. Fortunately, the research says you
don’t need perfection to see big benefits. Small, consistent improvements in the right areas
go a long way.
1. Nudge Your Diet Toward Whole Foods
Many cardiometabolic guidelines recommend a pattern similar to the Mediterranean or DASH (Dietary
Approaches to Stop Hypertension) diet: lots of vegetables, fruits, whole grains, beans, nuts,
olive oil, and fish, with limited ultra-processed foods, sugary drinks, and processed meats.
You don’t have to overhaul everything overnight. Start with practical swaps:
- Trade sugary drinks for water, sparkling water, or unsweetened tea.
- Add one extra serving of vegetables to lunch and dinner.
- Choose whole grains (like oats, brown rice, or whole-wheat bread) most of the time.
- Make fast food the exception, not the weekly habit.
Even modest shifts in diet quality can improve blood pressure, blood lipids, and blood sugar
over time, which directly improves cardiometabolic health.
2. Move More (Even If You Hate Gyms)
The standard recommendation is at least 150 minutes per week of moderate-intensity aerobic
activity, plus muscle-strengthening activities twice a week. But if you’re starting from “my
main workout is carrying groceries from the car,” any movement is an upgrade.
Try:
- 10-minute walks after meals (great for blood sugar and blood pressure).
- Taking the stairs when it’s reasonable, instead of the elevator.
- Bodyweight exercises at home (squats, wall push-ups, chair stands).
- Dancing in your living room like no one is watchingbecause hopefully no one is.
Regular movement helps with weight management, blood pressure, insulin sensitivity, and cholesterol
levelsall pillars of cardiometabolic health.
3. Get Serious About Sleep and Stress
Sleep isn’t just a “nice” recovery perk; it’s now part of the AHA’s cardiometabolic checklist.
Poor sleep is linked with obesity, diabetes, hypertension, and higher cardiovascular risk.
Aim for 7–9 hours of reasonably consistent sleep. Build a simple routine:
- Keep a regular bedtime and wake time.
- Limit screens for 30–60 minutes before bed.
- Use relaxation techniques (breathing exercises, stretching, or journaling).
Managing chronic stressthrough exercise, social connection, therapy, or mindfulnessalso helps
tame blood pressure and unhealthy coping habits like stress eating and smoking.
4. Know Your Numbers (and Check Them Regularly)
Cardiometabolic health is measurable, which is both reassuring and motivating. Talk with your
doctor about checking:
- Blood pressure
- Fasting glucose or A1C (for diabetes risk)
- Fasting lipids (cholesterol and triglycerides)
- Waist circumference and body mass index (with context)
Ask what your targets should be and how far you are from them. Watching your numbers improve
over time can be incredibly motivatinglike seeing your health score tick up in real life.
5. Use Medications When They’re Needed (No Shame In That)
Lifestyle changes are powerful, but they’re not always enough on their ownespecially if you
already have high blood pressure, diabetes, or very high cholesterol. Evidence-based medications
like statins, antihypertensives, and diabetes drugs can dramatically reduce your risk of heart
attack and stroke when used appropriately.
Needing medication doesn’t mean you’ve “failed.” It means you and your healthcare team are using
all the tools available to protect your heart and metabolism.
Real-World Experiences: What This Crisis Looks Like Up Close
Statistics can feel abstract. To really understand what it means that less than 1 in 15 people
in the U.S. have good cardiometabolic health, it helps to zoom in on the kinds of experiences
that play out every day in homes, clinics, and workplaces.
The “I Thought I Was Fine” Checkup
Picture someone in their mid-40swe’ll call him Markwho hasn’t seen a doctor in years because
he “feels fine.” He’s busy with work, kids, and the occasional weekend barbecue. He doesn’t
smoke, so he figures he’s doing okay.
At a routine physical, his blood pressure is 150/95. His fasting glucose is edging into
prediabetes territory. His LDL cholesterol is high, and his waist circumference quietly crossed
into metabolic syndrome range a few years ago. None of this hurt. None of it caused obvious
symptoms. But all of it has been quietly increasing his cardiometabolic risk.
For Mark, the turning point isn’t just hearing the numbersit’s having them explained in terms
of risk and possibility. When his doctor connects the dots (“This combination increases your
chance of a heart attack and stroke, but we can absolutely change your trajectory”), it becomes
less about “bad labs” and more about rewriting the story.
The Slow, Unflashy Win
Then there’s someone like Linda, in her late 50s, who has hypertension and borderline diabetes.
Her doctor suggests small, specific changes: walk 10–15 minutes after dinner, switch sugary
drinks for water most days, add veggies to lunch, and start a low-dose blood pressure medication.
Six months later, she hasn’t become a triathlete, and she still enjoys dessert on weekends. But
her blood pressure is down, she’s dropped 10 pounds, her fasting glucose has improved, and she
sleeps better. Her cardiometabolic health isn’t “perfect,” but it’s notably betterand her long-term
risk has meaningfully dropped.
These kinds of quiet, incremental victories rarely make headlines, but they’re exactly what it
looks like to move more people from the “unhealthy” side of the 1-in-15 statistic toward the
healthier side.
The Role of Community and Environment
Experiences also vary dramatically by where people live. In some neighborhoods, there are safe
sidewalks, parks, grocery stores with fresh produce, and multiple clinics nearby. In others,
people navigate food deserts, long commutes, unsafe streets, and limited access to preventive
care. Those environmental realities shape real lives.
A parent working two jobs in an area without reliable public transportation or affordable fresh
food faces very different choices than someone who can work remotely, shop easily, and join a
gym on the way home. When we talk about cardiometabolic health, we’re also talking about how
our systems supportor fail to supporthealthy choices.
What “Taking Charge” Really Looks Like
Improving cardiometabolic health doesn’t always mean dramatic transformations. More often, it
looks like:
- Buying a home blood pressure monitor and checking it twice a week.
- Asking your provider what your A1C and cholesterol numbers actually mean.
- Planning one or two simple, healthier dinners per week instead of trying a perfect meal plan.
- Replacing “I’m bad at this” with “I’m experimenting with small changes.”
- Leaning on friends, family, or support groups when change feels hard.
When you see cardiometabolic health as a spectrum rather than a pass/fail test, it becomes more
realisticand more encouragingto make progress. Every step toward lower blood pressure, better
blood sugar, improved cholesterol, and healthier weight counts.
Bringing It All Together
The fact that less than 1 in 15 adults in the U.S. have good cardiometabolic health is a serious
wake-up call. It reflects decades of lifestyle patterns, food systems, policies, and inequities
that have steered millions of people toward higher risk. But it’s not a reason to give up. It’s
a reason to get specific.
Knowing your numbers, understanding the main cardiometabolic risk factors, and using tools like
the AHA’s Life’s Essential 8 can help you see where you standand where the biggest opportunities
for improvement lie. Changing everything overnight isn’t realistic, but targeting one or two key
habits, checking in with your healthcare team, and making steady, sustainable changes can move
you into a healthier group over time.
The national statistics may look bleak, but at the individual level, cardiometabolic health is
incredibly modifiable. You can’t control the 15-person room the researchers are countingbut you
can absolutely work on which side of that 1-in-15 line you end up on.
