A CDC survey finds 4 in 5 US teenagers fall short of high heart health scores

By Tarun Sai LomteReviewed by Susha Cheriyedath, M.Sc.Oct 15 2026

From eating habits to sleep and exercise, a national survey examines how teenagers' cardiovascular health differs across student groups and where schools could make a difference.

Report: Cardiovascular Health Among High School Students - Youth Risk Behavior Survey, United States, 2025. Image Credit: EugeneEdge / Shutterstock

In a recent study published in the CDC’s Morbidity and Mortality Weekly Report, researchers assessed cardiovascular health (CVH) among high school students in the United States (US). The researchers found that approximately four in five students had low or moderate scores on five assessed cardiovascular health measures.

Cardiovascular diseases (CVDs) are the leading causes of mortality in the US, and many CVD risk factors emerge in childhood and adolescence. Data suggest a decline in optimal CVH among adults and an increase in the prevalence of prediabetes, obesity, and other risk factors in adolescents. Adolescence is a crucial period during which health behaviors develop and persist into adulthood.

Physical activity, body mass index (BMI), diet, sleep, and nicotine exposure are interrelated and independently associated with CVD. As such, assessing them together can help improve understanding of overall CVH. Reports suggest differences in CVH factors and behaviors by age, sex, and race/ethnicity, and that several CVH behaviors decrease as adolescents age.

About the study

The researchers assessed CVH using data from the Youth Risk Behavior Survey (YRBS) conducted in 2025. CVH was examined using five metrics: physical activity, diet, sleep health, BMI, and nicotine exposure, aligned with the American Heart Association’s LE8 scoring system, which covers eight measures of cardiovascular health. The survey did not assess other LE8 components, such as blood pressure, glucose, and lipid levels, because it does not involve physical examination or blood collection. Diet scores reflected reported fruit, vegetable, and sugary drink consumption, while nicotine scores excluded secondhand smoke exposure.

Each metric received a score from 0 to 100, with higher scores indicating more favorable levels. In addition, the team calculated an overall CVH score by averaging the individual metric scores. Scores were stratified into low (0–49), moderate (50–79), and high (80–100) CVH categories based on LE8 and clinical thresholds. The following demographic variables were considered: grade, sex, and race/ethnicity.

The researchers computed weighted mean scores for individual CVH metrics and the overall score, as well as weighted prevalence estimates for each category. Estimates were stratified by grade, sex, and race/ethnicity. Differences in overall and individual metric scores and the prevalence of high scores were examined by grade, sex, and race/ethnicity using design-adjusted t-tests.

Findings

The 2025 YRBS included 10,710 students; of these, 5,192 had available data on all five metrics. The included and excluded students had similar distributions by grade and sex, but White students accounted for 52.5% of the analytic sample, compared with 41.8% of excluded students. On average, the overall CVH score was moderate (65.3). The mean scores were low for diet (39.3), moderate for sleep health (59.1) and physical activity (62), and high for BMI (85.4) and nicotine exposure (80.5). Higher BMI scores indicated more favorable weight status, rather than higher BMI. BMI scores can remain favorable even when dietary quality is poor.

Females had lower overall CVH, sleep health, and physical activity scores, but had higher BMI scores than males. Students in grades 10–12 had lower overall scores than those in grade 9. Grade 12 students also had lower overall scores than grade 10 students. Asian students had the highest mean overall score, and Black students had the lowest. White and multiracial students had higher scores than Black and Hispanic students, while the researchers estimated Middle Eastern or North African students' scores less precisely.

Approximately 21% of students received a high overall score, 61% a moderate score, and 18% a low score. There was a lower prevalence of high overall scores among females and students in grades 10–12 than among males and grade 9 students, respectively. The prevalence of a high overall score was also lower in Hispanic and Black students compared to White, multiracial, and Middle Eastern or North African students. Because the survey was cross-sectional, comparisons between grades cannot establish changes in individual students over time.

Conclusions

Around 80% of high school students in the US had a moderate or low overall CVH score on this five-metric assessment. Among individual CVH metrics, nicotine exposure and BMI had the most favorable scores. By comparison, physical activity, diet, and sleep health had the least favorable scores, reflecting the need for improvement in these health behaviors. Differences in the overall score by grade, sex, and race/ethnicity were consistent with prior research.

The study’s limitations included reliance on self-reported measures, which may introduce reporting bias, and the absence of certain LE8 components. Approximately 52% of survey participants were excluded because their data were incomplete. Missing data resulted from student nonresponse, invalid responses, and differences in how the questionnaire was administered. The analytic sample had a higher proportion of White students than the excluded sample, which may affect generalizability. The five-metric scores should not be interpreted as a full clinical assessment of cardiovascular health.

These results highlight the importance of promoting healthy behaviors in early life for supporting better CVH in adulthood. The researchers also identified opportunities for school and community programs addressing diet, physical activity, sleep, and nicotine use.