J Am Heart Assoc
Strong cardio health tied to halved severe COVID risk
Clinical takeaway: Patients with low cardiovascular health may face higher risk for severe COVID-19, not just cardiovascular events. Vaccination and counseling on activity, weight, blood pressure, and sleep are especially worth emphasizing in this group.
People with cardiovascular disease have a known higher risk of severe COVID-19. What was unclear was whether more subtle differences in heart health mattered for adults without cardiovascular disease. This study tested that using the American Heart Association's Life's Essential 8 (LE8), a composite of diet, activity, smoking, sleep, BMI, blood pressure, lipids, and glucose.
Adults with high pre-pandemic LE8 scores (≥80) had a 46% lower hazard of severe COVID-19 than those with low scores (<50), with higher scores indicate better cardiovascular health. The pattern held across age, sex, race and ethnicity, education, and vaccination status. Overall COVID-19 infection rates were similar across cardiovascular health groups. The difference was in what happened after infection.
Four of the eight LE8 components carried the signal: physical activity, BMI, blood pressure, and sleep. Each was independently linked to lower severe COVID risk after mutual adjustment. Cholesterol, diet, and glucose were not. Not smoking did not show a protective effect, which the authors attribute to recent quitters in the cohort being sicker on average than continuing smokers.
The analysis drew from the C4R (Collaborative Cohort of Cohorts for COVID-19 Research) consortium, which pooled established US cohort studies with pre-pandemic data going back years to decades. The cohort included 29,740 adults without clinical cardiovascular disease; mean age was 66, 61% were women, and 34% identified as Hispanic. LE8 was calculated from each participant's most recent pre-pandemic assessment. There were 681 severe COVID-19 cases, defined as hospitalization or death, between March 2020 and February 2023. Just over half of participants were vaccinated at the time of the event or last follow-up.
The findings reframe cardiovascular health as a marker for infection resilience, not just future heart disease. The four actionable components (activity, weight, blood pressure, sleep) overlap with familiar lifestyle counseling and give that counseling broader stakes. Whether modifying these factors would change outcomes during a viral wave remains untested.
"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 senior author Elizabeth Oelsner, MD, DrPH, associate professor of medicine at Columbia University Irving Medical Center.
Source: Plante TB. J Am Heart Assoc. 2026 May 27. Life's Essential 8 and Risk of Severe COVID-19 Among Adults Without Clinical Cardiovascular Disease: The C4R Study