Atherosclerosis is a systemic disease with manifestations in multiple vascular beds. Ideal cardiovascular health (CVH) metrics relate to cardiovascular and cerebrovascular disease. However, the relation between ideal CVH metrics and asymptomatic polyvascular disease (polyVD) is unknown. We collected information on the 7 CVH metrics among 5,224 participants aged z40 years from 2010 to 2011. Intracranial artery stenosis, extracranial artery stenosis, and lower extremity artery disease were detected by transcranial Doppler, duplex sonography, and by calculating ankle -brachial index. Ordinal logistic regression and linear models were used to analyze the, relation between ideal CVH metrics and polyVD. PolyVD was identified in 158 (3%) participants. We observed a significant inverse gradient relation between the number of ideal CVH metrics and prevalence of polyVD after adjustment for potential confounders. The adjusted odds ratios and 95% confidence intervals were 0.824 (0.657 to 1.032), 0.641 (0.511 to 0.804), 0.538 (0.423 to 0.684), 0.583 (0.442 to 0.769), and 0.530 (0.348 to 0.808) for those having 2, 3, 4, 5, and 6 or 7 ideal CVH metrics, respectively, compared with those having 0 or 1 ideal CVH metric (p -trend <0.0001). Similarly, a larger number of ideal CVH metrics was associated with a lower prevalence of polyVD in the linear models (adjusted 13 coefficient 0.030, 95% confidence interval 0.041 to 0.020). Stratification for gender and age yielded consistent results in all subgroups except for women subgroup. In conclusion, we observed a significant inverse gradient association between the number of ideal CVH metrics and prevalence of asymptomatic polyVD. (C) 2017 Elsevier Inc. All rights reserved.