A 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 COVID-19 events, including hospitalization and death. The research, which analyzed data from nearly 30,000 adults without pre-existing cardiovascular disease, found that those with the highest scores on the American Heart Association's Life's Essential 8 metric were 46% less likely to experience severe COVID-19 compared to those with the lowest scores.
Life's Essential 8 evaluates eight key components of cardiovascular health: diet, physical activity, smoking status, sleep duration, body mass index, blood pressure, cholesterol, and blood sugar. For every 14-point increase in the overall score, the risk of severe COVID-19 dropped by 20%. Among individual components, higher physical activity, healthier weight, optimal blood pressure, and better sleep patterns were most strongly linked to reduced risk.
“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., 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, part of the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), included 29,740 adults with an average age of 66, of whom 61% were women. Participants were followed from March 2020 through February 2023, during which 681 severe COVID-19 cases were documented. The heart health benefit was consistent across age, sex, race, ethnicity, and vaccination status, and persisted as the pandemic evolved.
Senior study 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. At the beginning of the pandemic, we immediately saw that COVID-19 was a particularly severe stress on the body. 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 stressed the importance of vaccination, particularly for older adults and those with low heart health or heart disease.
The study adds to growing evidence that optimizing cardiovascular health may protect against severe outcomes from infections. However, because it was observational, it cannot establish cause and effect. Researchers assessed heart health only before or at the beginning of the pandemic and did not evaluate changes during the pandemic. The full manuscript is available online at the Journal of the American Heart Association website. Individuals can assess their own heart health using the American Heart Association’s My Life Check calculator.
