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Introduction: The American Heart Association (AHA) overall cardiovascular health (CVH) metric categorizes 7 targeted cardiovascular disease risk factors and health behaviors as "ideal," "intermediate," or "poor" for adults. We examined the association between these CVH categories and subsequent healthcare utilization in a large, diverse population. Methods: Kaiser Permanente Northern California (KPNC) is an integrated health care delivery system caring for >4.4 million members. We assessed 6 AHA metrics (smoking, physical activity, body mass index, blood pressure, total cholesterol, and blood glucose), each graded on a scale of 0 to 2, with 2 indicating "ideal" status, 1 "intermediate" status, and 0 "poor" status. Points were summed across health metrics to define three overall CVH categories: Poor (0-6), Intermediate (7-9) and Ideal (10-12). Individual-level health care utilization and costs (in 2015) were extracted from administrative databases for hospital, outpatient, pharmacy, emergency department (ED) and other services. We calculated average cost per patient from the total population, and then we determined costs for each service relative to the 'average cost per patient', across CVH categories and stratified by age categories. Results: Among 991,698 adult members (57.0% female) with all 6 metrics, 194,003 (19.6%) were age 18-39, 554,129 (55.9%) age 40-64, and 243,566 (24.6%) age ≥65 years. Poor CVH was present in 21.2%, intermediate CVH in 52.6% and ideal CVH in 26.2%. Overall costs increased monotonically across age categories, but better overall CVH was associated with lower relative cost in each age group (p<0.001 for trend; Figure). Conclusions: In a large real-world population, adults with ideal CVH had significantly lower total health care costs. Future research should consider pragmatic trials to test the clinical and cost-effectiveness of upstream wellness and prevention interventions to improve CVH. [ABSTRACT FROM AUTHOR]