Introduction: While a range of population-level and clinical interventions have been implemented to improve cardiometabolic (CM) health in the US, little is known about their different effects at the state-level. Objective: To develop a novel index to evaluate the performance of the healthcare system and population-level interventions to improve CM health at the state-level from 1990 to 2016. Methods: To evaluate healthcare access and quality, we estimated risk-standardized age-standardized mortality rates for six CM diseases that are amenable to healthcare. Risk-standardization removed geographic variation in all risk factors not directly amenable to medical intervention. To evaluate the effect of population-level interventions, we estimated the risk-weighted exposure to lifestyle risk factors including smoking, alcohol, diet, body mass index, and physical activity. We averaged the healthcare index with the risk factor index to create a single composite index. Data sources included mortality and risk factor estimates from the Global Burden of Disease 2016 Study. Results: Between 1990 and 2016, healthcare access and quality for CM diseases significantly improved in 38 states. These increases were mainly driven by significant improvements nationwide in healthcare for ischemic heart disease, ischemic stroke, and rheumatic heart disease. Notably, healthcare for diabetes significantly worsened in 16 states. There were no significant changes in the lifestyle risk factor index since 1990. Stability was driven by diverging trends, with smoking and diet quality significantly improving and BMI significantly worsening in all states. Importantly, the gap between the best and worst performing states across all indices increased between 1990 and 2016, indicating greater health disparities. Conclusions: This study has quantified the separate and combined effects of healthcare access, quality, and risk factors on CM health, with implications on priority setting for both population-level and clinical interventions.