A study published today in the Journal of the American Heart Association found that adults with better heart health before the COVID-19 pandemic were significantly less likely to experience severe outcomes from the infection. The research, which analyzed nearly 30,000 adults without prior cardiovascular disease, revealed that those with the highest scores on the American Heart Association’s Life’s Essential 8 metric had a 46% lower risk of COVID-19 hospitalization or death compared to those with the lowest scores.
The study, led by Tim Plante, M.D., M.H.S., an associate professor of medicine at the Larner College of Medicine at the University of Vermont, is among the first to use the Life’s Essential 8 metrics to examine the relationship between heart health and severe COVID-19. Life’s Essential 8 assesses eight components: diet, physical activity, smoking, sleep, body mass index, blood pressure, cholesterol, and blood sugar. The findings suggest that improving heart health could have mitigated the pandemic’s toll, which caused 1.22 million deaths in the U.S. between March 2020 and March 2025.
Researchers analyzed data from the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), which includes 14 U.S. studies with long-term health information collected before the pandemic. Among the 29,740 participants, average age 66 and 61% women, 18% had high heart health (scores 80-100), 70% moderate, and 12% low (scores below 50). During the study period from March 2020 to February 2023, there were 681 severe COVID-19 cases, defined as hospitalization or death. The results showed that each 14-point increase in Life’s Essential 8 score was associated with a 20% lower risk of severe COVID-19.
Specific components that individually reduced risk included better physical activity, healthier weight, optimal blood pressure, and good sleep patterns. Senior author Elizabeth C. Oelsner, M.D., Dr.P.H., associate professor of medicine at Columbia University Irving Medical Center, noted, “In many ways, a viral infection is like a cardiac stress test, except it’s not controlled. 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.”
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, emphasized that “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.” She also underscored the importance of vaccination, particularly for older adults and those with low heart health or heart disease.
The study’s strengths include its large, diverse sample—35% white, 34% Hispanic/Latino, and 22% Black adults—and the use of pre-pandemic data. Limitations include its observational nature, which cannot prove cause and effect, and the fact that heart health was only measured at the start of the pandemic. The heart health benefit was consistent across age, sex, race, ethnicity, and vaccination status, and persisted as the pandemic evolved.
The findings add to evidence that maintaining heart health is crucial not only for cardiovascular disease prevention but also for resilience against severe infections. As Plante concluded, “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.”
