This study evaluated whether positive health attitudes were associated with healthy behaviors in individuals with cardiovascular disease (CVD) or moderate coronary heart disease (CHD) risk. Self-reported health attitudes and behaviors were assessed in the US Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD) for respondents with CVD and type 2 diabetes mellitus (very high risk), CVD and no diabetes (high risk), or moderate CHD risk. CVD was defined as a diagnosis of heart disease/heart attack, stroke, obstructed coronary arteries, or revascularization. Moderate CHD risk was defined as >/=2 Framingham risk factors. Comparisons across very high-risk (n=1177), high-risk (n=2202), and moderate-risk (n=6802) respondents were made using analysis of variance. The proportion of respondents reporting excellent or very good current health decreased with increasing risk (37% of moderate-risk, 21% of high-risk, and 13% of very high-risk respondents). The proportion concerned that their health problems might worsen increased with increasing risk (55%, 63%, and 74%). With increasing risk, 28%, 26%, and 31% exercised regularly and 58%, 52%, and 54% maintained their desired weight for >6 months. Respondents with positive health attitudes were more likely to exercise regularly and maintain desired weight compared with respondents with negative health attitudes (P<.01). Respondents had an average of 3 or 4 family doctor office visits in the past year. Most respondents with CVD or moderate CHD risk had negative health attitudes and were not employing healthy behaviors with regard to exercise and weight management. Frequent family doctor visits are an opportunity to improve the delivery of personalized health education and intervention programs.