A new study published today in the Journal of the American Heart Association found that better heart health before the COVID-19 pandemic was associated with a significantly lower risk of severe COVID-19 outcomes, including hospitalization and death. The research, conducted by the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), analyzed data from nearly 30,000 adults without clinical cardiovascular disease at the start of the pandemic.
The study used the American Heart Association’s Life’s Essential 8 metric, which measures diet, physical activity, smoking, sleep, body mass index, blood pressure, cholesterol and blood sugar. Participants were scored on a 0 to 100 scale, with higher scores indicating better cardiovascular health. The analysis revealed that adults with high Life’s Essential 8 scores (80 to 100) had a 46% reduction in risk of COVID-19 hospitalization or death compared to those with low scores (less than 50). Additionally, for every 14-point increase in score, the risk of severe COVID-19 was lower by 20%.
“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,” 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. “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.”
Among the individual components of Life’s Essential 8, higher scores for physical activity, body mass index, blood pressure and sleep were most strongly associated with reduced risk. The findings held across different age, sex, race, ethnicity and vaccination status groups, and persisted as the pandemic evolved and vaccines became available.
“The findings suggest that having a healthy heart helps the body deal with the stress of a viral infection like COVID-19,” said senior study author Elizabeth C. Oelsner, M.D., Dr.P.H., associate professor of medicine at Columbia University Irving Medical Center. “In many ways, a viral infection is like a cardiac stress test, except it’s not controlled.”
The study included 29,740 adults with an average age of 66, of whom 61% were women. About 18% had high heart health, 70% had moderate heart health and 12% had low heart health. There were 681 severe COVID-19 cases documented between March 1, 2020 and February 28, 2023. The researchers noted that 53% of participants had received a COVID-19 vaccination before infection.
“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. She emphasized the importance of vaccination, particularly for older adults and those with low heart health or heart disease.
The study was observational and could not establish cause and effect. Heart health was measured only before or at the beginning of the pandemic, and changes during the pandemic were not assessed. Nonetheless, the findings highlight the potential role of cardiovascular health in mitigating the severity of infectious diseases.
