AbstractPurposeTo examine associations of adolescent body mass index (BMI), tobacco use, and physical activity with optimal physiologic cardiovascular health (CVH) in adulthood.MethodsData were from 12,139 participants in Waves I (1995–1996) and IV (2007–2008) of the National Longitudinal Study of Adolescent Health. We defined optimal CVH as normal blood pressure, glucose, and cholesterol without diabetes or cardiovascular disease. We used logistic regression to estimate odds of having optimal CVH at ages 24–32 years (Wave IV) according to BMI category, smoking status, and physical activity at ages 11–19 years (Wave I).ResultsFew young adults (16%) had optimal CVH. Adolescents with normal BMI were more than twice as likely to have optimal young adult CVH compared to those who were obese (adjusted odds ratio, 2.77; 95% confidence interval, 1.97–3.89). Adolescent smoking and physical activity did not predict young adult CVH.ConclusionsLower adolescent BMI is associated with young adult CVH