New research published today in the Journal of the American Heart Association reveals that better heart health before the COVID-19 pandemic was associated with a lower risk of severe COVID-19 outcomes, including hospitalization and death. The study, which analyzed data from nearly 30,000 adults without pre-existing cardiovascular disease, found that those with the highest heart health scores were nearly half as likely to experience severe COVID-19 compared to those with the lowest scores.
Using the American Heart Association's Life's Essential 8 metric—which evaluates diet, physical activity, smoking, sleep, body mass index, blood pressure, cholesterol, and blood sugar—researchers assessed heart health at the start of the pandemic. Adults with scores of 80-100 had a 46% reduction in risk of severe COVID-19 compared to those with scores below 50. For every 14-point increase in score, the risk dropped by 20%.
“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 at the Larner College of Medicine at the University of Vermont. “Our findings suggest that the tremendous impact of COVID-19 could have been reduced if the general population had had better heart health prior to the onset of the pandemic.”
Specifically, higher physical activity, healthier body mass index, optimal blood pressure, and better sleep patterns were individually associated with lower risk. Senior author Elizabeth C. Oelsner, M.D., Dr.P.H., from Columbia University Irving Medical Center, noted that “in many ways, a viral infection is like a cardiac stress test, except it’s not controlled.” She added that better heart health likely prepares the body for real-life stress tests such as infectious diseases.
The study, part of the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), included adults with an average age of 66 years, 61% women, and diverse racial and ethnic backgrounds. The heart health benefit was consistent across age, sex, race, ethnicity, and vaccination status, and persisted as the pandemic evolved. However, the study was observational and could not establish cause and effect.
Sadiya S. Khan, M.D., M.Sc., FAHA, chair of the American Heart Association’s Epidemiology Statistic Committee, emphasized that “healthy lifestyle habits make a difference for preventing heart disease and also for more direct health benefits such as preventing adverse outcomes from respiratory infections.” Khan also highlighted the importance of vaccination, especially for older adults or those with low heart health.
The findings underscore the importance of maintaining optimal heart health not only for cardiovascular disease prevention but also for resilience against severe infections. More details are available in the manuscript and the American Heart Association’s My Life Check calculator.
