Better heart health before the pandemic was linked to a lower risk of severe COVID-19 events, according to research published today in the Journal of the American Heart Association, an open-access, peer-reviewed journal of the American Heart Association. Adults with highest heart health scores at the beginning of the pandemic were nearly half as likely to be hospitalized or die from COVID-19 when compared to those with the lowest scores.
People with cardiovascular disease are known to be at a greater risk for severe COVID-19 infection, defined in this study as hospitalization or death. What wasn't known was how heart health related to severe COVID-19 among adults without cardiovascular disease. The study, which analyzed nearly 30,000 adults without clinical cardiovascular disease as of March 2020, found that those with high heart health scores (80 to 100 on the American Heart Association's Life's Essential 8 metric) had a 46% reduction in risk of COVID-19 hospitalization or death compared to those with low scores (less than 50). For every 14-point increase in score, the risk decreased 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.”
The Life's Essential 8 metric considers diet, physical activity, smoking, sleep, body mass index, blood pressure, cholesterol and blood sugar. Higher scores for physical activity, healthier weight, optimal blood pressure and sleep patterns were individually associated with lower risk of severe COVID-19. “The findings suggest that having a healthy heart helps the body deal with the stress of a viral infection like COVID-19,” according to 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.”
Sadiya S. Khan, M.D., M.Sc., FAHA, chair of the American Heart Association's Epidemiology Statistic Committee, who was not involved in this research, noted that the study adds to evidence that better heart health “is important not just to protect people from heart disease but for protection from adverse outcomes from infections such as COVID-19 and for overall health.” She also emphasized the importance of vaccination, particularly in older adults and those with low heart health or heart disease.
The analysis was 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 years, 61% were women, and 18% had high heart health. There were 681 severe COVID-19 cases documented between March 1, 2020 and February 28, 2023. The heart health benefit was similar across age, sex, race, ethnicity and vaccination status, and persisted as the pandemic evolved. Study limitations include its observational nature and that heart health was only measured before or at the beginning of the pandemic.
“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 Khan. More research is needed, but the findings highlight the importance of cardiovascular health in preparing the body for severe infections.
