Background <p>Cardiovascular disease (CVD) disproportionately affects racial and ethnic minorities, and disparities in sleep health may significantly contribute to these inequalities. Historically, the lack of representation of minorities in sleep research, along with a narrow focus on specific sleep measures, has limited our understanding of the role of sleep health in CVD disparities.</p> Objectives <p>This study aimed to investigate racial and ethnic disparities in CVD risk and to explore whether a composite sleep measure, multidimensional sleep health (MDSH), mediates or moderates these disparities using nationally representative data.</p> Methods <p>We analyzed data for 5,098 adults ages 30 to 80 years without existing diagnosed CVD from the 2017–2020 National Health and Nutrition Examination Survey (NHANES). CVD risk was measured using the Framingham Risk Score (FRS). Multivariable ordinal logistic models examined associations between race and ethnicity with FRS, adjusting for covariates. We conducted tests of the mediating and moderating role of MDSH in these associations.</p> Results <p>Asians and Hispanics exhibited significantly lower odds of CVD risk compared to Whites. In contrast, Black and other race including multi-racial individuals showed no differences in CVD risk compared to Whites. MDSH did not significantly mediate differences in CVD risk by race/ethnicity. However, there was a moderating effect of MDSH, such that Asians and Hispanics had much lower CVD risk than Whites when they had ideal MDSH, while the same groups had similar CVD risk when MDSH was poor.</p> Conclusion <p>MDSH may play a different role in CVD risk, depending on race and ethnicity.</p>