Early childhood programs show promise in reducing cardiovascular risks and combating racial and income disparities. However, most previous studies had small sample sizes, unreplicable program elements, retrospective designs, and measurement problems. In a study of the Child-Parent Centers (CPC) program, preschool was associated with lower 30-year Framingham risk scores by age 37 years. Generalizability to broader cardiovascular health is unknown. This cohort study assessed whether preschool is associated with long-term cardiovascular health measured by the American Heart Association (AHA) Ideal Cardiovascular Health Index (iCVH) and whether educational attainment accounts for this association. (author abstract)