This study investigates the relationship between overactive bladder (OAB) and cardiovascular health (CVH) in American adults using the Life’s Essential 8 (LE8) score, a composite index of health behaviors and factors. The research utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2018, involving 70,190 individuals. The LE8 score, which includes sleep, smoking, daily exercise, diet, BMI, non-HDL-C, blood sugar, and blood pressure, was used as the independent variable, while the presence of OAB was the dependent variable. Multivariable logistic regression and restricted cubic splines were employed to evaluate the association, with interaction analyses conducted on subgroups. Key findings include a significant negative correlation between LE8 scores and OAB prevalence. A 10-point increase in the LE8 score was associated with a 17% decrease in the odds of OAB [OR: 0.83 (95% CI: 0.78, 0.89)]. Participants with higher LE8 scores had a 46% lower probability of developing OAB compared to those with lower scores. Subgroup analyses revealed a stronger negative correlation between LE8 scores and OAB among non-smokers. The study highlights the potential influence of CVH on OAB and suggests that monitoring and improving CVH through the LE8 score may help reduce OAB incidence. The study's limitations include its cross-sectional design, which precludes establishing causality, and the reliance on self-reported data for OAB diagnosis, which may introduce measurement errors. Despite these limitations, the findings provide valuable insights for the management and prevention of OAB.This study investigates the relationship between overactive bladder (OAB) and cardiovascular health (CVH) in American adults using the Life’s Essential 8 (LE8) score, a composite index of health behaviors and factors. The research utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2018, involving 70,190 individuals. The LE8 score, which includes sleep, smoking, daily exercise, diet, BMI, non-HDL-C, blood sugar, and blood pressure, was used as the independent variable, while the presence of OAB was the dependent variable. Multivariable logistic regression and restricted cubic splines were employed to evaluate the association, with interaction analyses conducted on subgroups. Key findings include a significant negative correlation between LE8 scores and OAB prevalence. A 10-point increase in the LE8 score was associated with a 17% decrease in the odds of OAB [OR: 0.83 (95% CI: 0.78, 0.89)]. Participants with higher LE8 scores had a 46% lower probability of developing OAB compared to those with lower scores. Subgroup analyses revealed a stronger negative correlation between LE8 scores and OAB among non-smokers. The study highlights the potential influence of CVH on OAB and suggests that monitoring and improving CVH through the LE8 score may help reduce OAB incidence. The study's limitations include its cross-sectional design, which precludes establishing causality, and the reliance on self-reported data for OAB diagnosis, which may introduce measurement errors. Despite these limitations, the findings provide valuable insights for the management and prevention of OAB.