Better heart health before the COVID-19 pandemic was associated with a lower risk of severe outcomes from the infection, according to a study published today in the Journal of the American Heart Association. The research, which analyzed data from nearly 30,000 adults without prior cardiovascular disease, found that those with the highest scores on the American Heart Association's Life's Essential 8 metric were nearly half as likely to be hospitalized or die from COVID-19 compared to those with the lowest scores.
Life's Essential 8 is a heart health metric that considers diet, physical activity, smoking, sleep, body mass index, blood pressure, cholesterol, and blood sugar. The study is among the first to use this comprehensive measure to examine the relationship between heart health and severe COVID-19. "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," said lead author Tim Plante, M.D., M.H.S., associate professor of medicine at the Larner College of Medicine at the University of Vermont.
The analysis included 29,740 adults with an average age of 66, of whom 61% were women. About 18% had high heart health (scores 80-100), 70% moderate, and 12% low (scores less than 50). Between March 2020 and February 2023, 681 severe COVID-19 cases were documented, defined as hospitalization or death. After adjusting for various factors, those with high heart health scores had a 46% reduction in risk of severe COVID-19 compared to those with low scores. For every 14-point increase in the Life's Essential 8 score, the risk dropped by 20%.
Individual components of the metric showed strong associations: higher physical activity, healthier body mass index, optimal blood pressure, and better sleep patterns were each linked to lower risk. "In many ways, a viral infection is like a cardiac stress test, except it's not controlled," said senior author Elizabeth C. Oelsner, M.D., Dr.P.H., associate professor of medicine at Columbia University Irving Medical Center. "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."
The study's findings underscore the importance of maintaining cardiovascular health not just for preventing heart disease but also for resilience against infections. 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 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 emphasized the importance of vaccination, especially for older adults or those with low heart health.
The research is part of the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), a collaboration of 14 U.S. studies with long-term health data. The benefit of better heart health was consistent across age, sex, race, ethnicity, and vaccination status. However, the study was observational and cannot establish cause and effect, and heart health was only measured before or at the start of the pandemic. Further research is needed to explore changes over time.
The findings were published in the Journal of the American Heart Association, an open-access peer-reviewed journal. More information on Life's Essential 8 is available through the My Life Check calculator.
