Better heart health before the pandemic was associated with a lower risk of severe COVID-19 events, according to research published today in the Journal of the American Heart Association. Adults with the highest heart health scores at the beginning of the pandemic were nearly half as likely to be hospitalized or die from COVID-19 compared to those with the lowest scores.
People with cardiovascular disease are known to be at greater risk for severe COVID-19 infection, defined in this study as hospitalization or death. What was not known was how heart health related to severe COVID-19 among adults without cardiovascular disease. The study, published in the Journal of the American Heart Association, analyzed nearly 30,000 adults and used the American Heart Association's Life's Essential 8 metric to assess heart health.
"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 study found 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 heart health scores (less than 50). For every 14-point increase in Life's Essential 8 score, the risk of COVID-19 hospitalization or death was lower by 20%. Higher scores for physical activity, body mass index, blood pressure and sleep were individually associated with lower risk.
"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, part of the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), included 29,740 adults without clinical cardiovascular disease as of March 2020, with an average age of 66 years. About 18% had high heart health, 70% moderate, and 12% low heart health. There were 681 severe COVID-19 cases documented between March 2020 and February 2023.
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, noted the importance of healthy lifestyle habits. "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." Khan also emphasized the importance of vaccination, particularly in older adults and those with low heart health. The study's results can be explored further using the My Life Check calculator to assess cardiovascular health.
The heart health benefit was similar across groups by 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.
