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Purpose. We examined the cardiovascular health profiles of benefit-eligible hospital employees who participated in an incentive screen program for 4 years. We also determined if cardiovascular health changes differed between participants (CHAP) who enrolled in structured follow-up risk reduction programs (CHAPplus) compared with those who chose less formal options (CHAPonly). Methods. CHAP consisted of cardiovascular screens, results counseling, and encouragement to participate in education and behavioral support programs. After adjusting for gender, medication use, and baseline levels of adiposity and physical activity, cardiovascular health changes were tested with repeated-measures analysis of covariance (ANCOVA) among CHAP participants and by CHAP type. Results. CHAP 4-year members (n = 278) were generally healthy and mostly women (87%) with an average age of 40.6 ± .5 years at baseline. Despite increases in overall (p = .034) and central adiposity (p = .001), cardiovascular health improvements were found for the total cholesterol/high-density lipoprotein ratio (TCHOL/HDL; p = .007), low-density lipoprotein (p = .009), and blood glucose (p = .018) among 4-year CHAP members. CHAPonly employees showed greater improvements in most cardiovascular health indicators than CHAPplus participants, although these differences did not achieve statistical significance. Discussion. Cardiovascular health improvements were associated with long-term participation in a hospital worksite incentive screen program. The cardiovascular health benefits tended to be greatest for CHAP employees who chose informal follow-up risk reduction options (CHAPonly) than those who enrolled in structured programs (CHAPplus).