A new study published today in the Journal of the American Heart Association reveals that better heart health before the COVID-19 pandemic was associated with a significantly lower risk of severe infection, including hospitalization or death. The research, which analyzed data from nearly 30,000 U.S. adults without prior cardiovascular disease, found that those with the highest scores on the American Heart Association's Life's Essential 8 metric were nearly half as likely to experience severe COVID-19 outcomes compared to those with the lowest scores.
"Our findings suggest that the tremendous impact of COVID-19 on the U.S. could have been reduced if the general population had had better heart health prior to the onset of the pandemic," said lead study author Tim Plante, M.D., M.H.S., an associate professor of medicine at the Larner College of Medicine at the University of Vermont. The study is one of the first to use Life's Essential 8, which assesses diet, physical activity, smoking, sleep, body mass index, blood pressure, cholesterol and blood sugar, to examine the relationship between heart health and COVID-19 severity.
The analysis included 29,740 participants from the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), a collaboration of 14 U.S. studies that recruited participants years before the pandemic. Participants had an average age of 66, 61% were women, and none had clinical cardiovascular disease as of March 2020. Over the study period from March 1, 2020 to February 28, 2023, 681 severe COVID-19 cases were documented.
Key findings include a 46% reduction in risk of COVID-19 hospitalization or death for adults with high Life's Essential 8 scores (80-100) compared to those with low scores (less than 50). For every 14-point increase in the score, the risk dropped by 20%. Among individual components, higher physical activity, healthier body mass index, optimal blood pressure and better sleep patterns were most strongly associated with reduced risk.
"In many ways, a viral infection is like a cardiac stress test, except it’s not controlled," said senior author Elizabeth C. Oelsner, M.D., Dr.P.H., an associate professor at Columbia University Irving Medical Center. "Our results highlight that better heart health, which is something that individuals can work on, likely prepares you better for real-life stress tests such as infectious diseases like COVID-19."
The heart health benefit was consistent across age, sex, race, ethnicity and vaccination status, and persisted as the pandemic evolved and vaccines became available. However, the study was observational and could not establish cause and effect. Heart health was only measured before or at the beginning of the pandemic, so changes during the pandemic were not assessed.
"Healthy lifestyle habits make a difference for preventing heart disease, which can sometimes feel like a vague and far-off goal for people, and also for more direct health benefits such as preventing adverse outcomes from respiratory infections," said Sadiya S. Khan, M.D., M.Sc., FAHA, chair of the American Heart Association’s Epidemiology Statistic Committee, who was not involved in the research. Khan also emphasized the importance of vaccination, particularly for older adults and those with low heart health or heart disease.
The study underscores the importance of cardiovascular health in mitigating the impact of infectious diseases. "COVID-19 caused 1.22 million deaths in the U.S. between March 2020 and March 2025, so it’s essential that we understand how important health components, such as heart health, relate to severity of COVID-19 infections," Plante noted.
For more information on assessing heart health, the American Heart Association offers the My Life Check calculator. The full manuscript is available online at the Journal of the American Heart Association.
