Objective We studied in European adolescents (i) the association between cardiorespiratory fitness and ideal cardiovascular health as defined by the American Heart Association and (ii) whether there is a cardiorespiratory fitness threshold associated with a more favourable cardiovascular health profile. Methods Participants included 510 (n=259 girls) adolescents from 9 European countries. The 20 m shuttle run test was used to estimate cardiorespiratory fitness. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviours (smoking, body mass index, physical activity and diet) and three factors (total cholesterol, blood pressure and glucose). Results Higher levels of cardiorespiratory fitness were associated with a higher number of ideal cardiovascular health components in both boys and girls (both p for trend ≤0.001). Levels of cardiorespiratory fitness were significantly higher in adolescents meeting at least four ideal components (13% higher in boys, p