This study investigates the association between cardiovascular health (CVH), measured by the Life's Essential 8 (LE8) score, and overactive bladder (OAB) in American adults. Using data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005–2018, the study analyzed 70,190 participants, with 25,850 included after excluding those with missing data. The LE8 score, based on four health behaviors and four health factors, was found to have a significant negative correlation with OAB. A 10-point increase in LE8 score was associated with a 17% decrease in the odds of OAB. Participants with higher LE8 scores had a 46% lower probability of developing OAB compared to those with lower scores. The study also found significant interactions between LE8 scores and smoking status, with nonsmokers showing a stronger negative correlation with OAB. The findings suggest that better cardiovascular health is linked to a lower risk of OAB, highlighting the importance of monitoring and improving cardiovascular health to reduce OAB incidence. The study provides new insights into the relationship between cardiovascular health and OAB, offering potential strategies for prevention and management of OAB in clinical practice. However, the study's cross-sectional design limits the establishment of causality, and the reliance on self-reported data may introduce measurement errors. Despite these limitations, the study contributes to the understanding of the relationship between cardiovascular health and OAB, emphasizing the role of LE8 in assessing cardiovascular health and OAB risk.This study investigates the association between cardiovascular health (CVH), measured by the Life's Essential 8 (LE8) score, and overactive bladder (OAB) in American adults. Using data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005–2018, the study analyzed 70,190 participants, with 25,850 included after excluding those with missing data. The LE8 score, based on four health behaviors and four health factors, was found to have a significant negative correlation with OAB. A 10-point increase in LE8 score was associated with a 17% decrease in the odds of OAB. Participants with higher LE8 scores had a 46% lower probability of developing OAB compared to those with lower scores. The study also found significant interactions between LE8 scores and smoking status, with nonsmokers showing a stronger negative correlation with OAB. The findings suggest that better cardiovascular health is linked to a lower risk of OAB, highlighting the importance of monitoring and improving cardiovascular health to reduce OAB incidence. The study provides new insights into the relationship between cardiovascular health and OAB, offering potential strategies for prevention and management of OAB in clinical practice. However, the study's cross-sectional design limits the establishment of causality, and the reliance on self-reported data may introduce measurement errors. Despite these limitations, the study contributes to the understanding of the relationship between cardiovascular health and OAB, emphasizing the role of LE8 in assessing cardiovascular health and OAB risk.