Healthy hearts prior to pandemic reduced severe COVID-19 risk

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.

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. 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."

Tim Plante, M.D., M.H.S., lead study author, associate professor of medicine at the Larner College of Medicine, University of Vermont and internal medicine physician with University of Vermont Health, both in Burlington, Vermont

Researchers determined the heart health of nearly 30,000 people using the American Heart Association's Life's Essential 8 metric, which considers diet, physical activity, smoking, sleep, body mass index, blood pressure, cholesterol and blood sugar. This study may be the first to leverage the Life's Essential 8 metrics to examine the relationships among heart health, the risk of severe COVID-19 infection, and other factors.

The analysis found:

• 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 more 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 New York City.

"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," said Oelsner.

While more research is needed, the study adds to the growing 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," said 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.

"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, who is the Magerstadt Professor of Cardiovascular Epidemiology and an associate professor of cardiology and preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago.

Khan notes that the study also emphasizes the importance of vaccination to prevent complications, particularly in those who are older, with low heart health or a diagnosis of heart disease. 

Study details, background, design and limitations:

• The analysis is 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. The cohorts have extensive, long-term health information, including information on clinical cardiovascular disease, lifestyle, mental health, laboratory biomarkers and social determinants of health.
• This analysis included 29,740 adults without clinical cardiovascular disease as of March 2020, with an average age of 66 years, and of whom 61% were women. About 18% of study participants had high heart health, 70% had moderate heart health and 12% had low heart health. Participants self-selected race and ethnicity, and 35% were white adults; 34% were Hispanic/Latino adults; and 22% were Black adults.
• There were 681 severe COVID-19 cases documented by C4R between March 1, 2020 and February 28, 2023. COVID-19 was self-reported and confirmed via blood testing and hospital and death records.
• 53% of participants were known to have received a COVID-19 vaccination before experiencing COVID-19.
• The heart health benefit with respect to severe COVID-19 risk was similar across groups by age, sex, race, ethnicity and vaccination status, and persisted as the pandemic evolved and vaccines became available.
• Study limitations include that it was observational, meaning that it could not establish cause and effect. Heart health was only measured before or at the beginning of the COVID-19 pandemic. Changes in heart health related to severe COVID-19 infection during the pandemic were not assessed.