Background Our objective was to determine whether persons with coronary heart disease (CHD) were more likely to engage in healthy lifestyle behaviors (HLBs) than persons without CHID. Design Cross-sectional study. Methods Data from the 2000 Behavioral Risk Factor Surveillance System (BRFSS) (n=35677) were analyzed. HLBs included maintaining an ideal body weight (body mass index < 25.0), eating five or more fruits and vegetables daily, performing at least 30 minutes of leisure time physical activity (LTPA) at least five times per week and non-smokers (former and never smokers). Logistic regression was used to determine whether persons with CHD were more likely to engage in all four HLBs than persons without CHID after adjusting for age, sex, race and education. Results Only 6.3% of persons with CHID and 6.8% among persons without CHD engaged in all four HLBs. In the crude analysis, persons with CH D were 10% less likely than persons without CH D to engage in all four HLBs [odds ratio (OR)=0.9; 95% confidence interval (CI)=0.7-1.3]. After adjusting for covariates, persons with CHD were equally as likely to engage in all four HLBs as persons without CH D (OR= 1.0; 95% Cl = 0.7-1.3). Conclusions Overall, only a small proportion of persons engaged in all four HLBs. After adjusting for covariates, persons with CHID were just as likely as persons without CHID to engage in all four HLBs. Additional efforts are needed to increase the proportion of adults engaging in all four HLBs, particularly among persons with CHD. J Cardiovasc Risk 10:207-212 (C) 2003 Lippincott Williams Wilkins.