Life's Essential 8 and Risk of Severe COVID‐19 Among Adults Without Clinical Cardiovascular Disease: The C4R Study

BACKGROUND: Cardiovascular disease is a risk factor for severe COVID-19 (ie, hospitalization or death). Whether better cardiovascular health (CVH) is associated with lower risk of severe COVID-19 among adults without cardiovascular disease is unknown. We aimed to test if the American Heart Association's Life's Essential 8 (LE8) metric and its components were associated with severe COVID-19 in the C4R (Collaborative Cohort of Cohorts for COVID-19 Research) consortium. METHODS: Participants with cardiovascular disease were excluded. Two waves of questionnaires, events surveillance, and a serosurvey identified COVID-19 infections. Associations of incident severe COVID-19 with continuous LE8, categorical LE8 (low [<50], moderate [50 to <80], and high [≥80] CVH), and individual LE8 components, were tested in adjusted cause-specific hazards models. RESULTS: Among 29 740 participants in 9 cohorts (mean age, 66±14 years; 61% women; 35% White race; 22% Black race; 34% Hispanic ethnicity), there were 681 severe COVID-19 cases between March 1, 2020, and February 28, 2023. There was a 20% lower hazard of severe COVID-19 per each 1-SD higher LE8 (adjusted hazard ratio [aHR], 0.80 [95% CI, 0.73-0.88]). Relative to low CVH, high CVH was associated with lower risk of severe COVID-19 (aHR, 0.54 [95% CI, 0.37-0.78]); this was not seen for moderate CVH (aHR, 0.81 [95% CI, 0.64-1.04]). Of LE8 components, better physical activity, body mass index, blood pressure, and sleep were associated with a lower hazard of severe COVID-19. CONCLUSIONS: Better CVH was associated with lower severe COVID-19 risk among cardiovascular disease-free adults. Whether CVH optimization could mitigate adverse risk from COVID-19 and other harmful viruses warrants further investigation.

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Journal
Journal of the American Heart Association
Published
2026-04-27
DOI
https://doi.org/10.1161/jaha.125.048256
Primary Topic
Cardiovascular Health and Risk Factors
Type
article
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article

Life's Essential 8 and Risk of Severe COVID‐19 Among Adults Without Clinical Cardiovascular Disease: The C4R Study

Timothy B. Plante, Amanda M. Fretts, Gregory A. Talavera, Mary Cushman et al.
Journal of the American Heart Association
Cardiovascular Health and Risk Factors
article

Life's Essential 8 and Risk of Severe COVID‐19 Among Adults Without Clinical Cardiovascular Disease: The C4R Study

Timothy B. Plante, Amanda M. Fretts, Gregory A. Talavera, Mary Cushman, H Wang, Tatjana Rundek, Norrina B. Allen, Monika M. Safford, Emily B Levitan, Stephen Paul Juraschek, Nathalie Pamir, MORGANA MONGRAW-CHAFFIN, Daniela Sotres‐Alvarez, Arnita F. Norwood, Elizabeth C. Oelsner, Vanessa Xanthakis, Debora Kamin Mukaz, Pallavi Balte, Suzanne E. Judd, Virginia J. Howard, Kelley Pettee Gabriel, Martha L. Daviglus, Sameera A. Talegawkar, Neil A. Zakai, M Mitchell S Elkind, Jose Gutierrez, Sara Gonzalez, Namratha Kandula, Donald Lloyd-Jones, Hongyan Ning, Yifei Sun
article en

Abstract

BACKGROUND: Cardiovascular disease is a risk factor for severe COVID-19 (ie, hospitalization or death). Whether better cardiovascular health (CVH) is associated with lower risk of severe COVID-19 among adults without cardiovascular disease is unknown. We aimed to test if the American Heart Association's Life's Essential 8 (LE8) metric and its components were associated with severe COVID-19 in the C4R (Collaborative Cohort of Cohorts for COVID-19 Research) consortium. METHODS: Participants with cardiovascular disease were excluded. Two waves of questionnaires, events surveillance, and a serosurvey identified COVID-19 infections. Associations of incident severe COVID-19 with continuous LE8, categorical LE8 (low [<50], moderate [50 to <80], and high [≥80] CVH), and individual LE8 components, were tested in adjusted cause-specific hazards models. RESULTS: Among 29 740 participants in 9 cohorts (mean age, 66±14 years; 61% women; 35% White race; 22% Black race; 34% Hispanic ethnicity), there were 681 severe COVID-19 cases between March 1, 2020, and February 28, 2023. There was a 20% lower hazard of severe COVID-19 per each 1-SD higher LE8 (adjusted hazard ratio [aHR], 0.80 [95% CI, 0.73-0.88]). Relative to low CVH, high CVH was associated with lower risk of severe COVID-19 (aHR, 0.54 [95% CI, 0.37-0.78]); this was not seen for moderate CVH (aHR, 0.81 [95% CI, 0.64-1.04]). Of LE8 components, better physical activity, body mass index, blood pressure, and sleep were associated with a lower hazard of severe COVID-19. CONCLUSIONS: Better CVH was associated with lower severe COVID-19 risk among cardiovascular disease-free adults. Whether CVH optimization could mitigate adverse risk from COVID-19 and other harmful viruses warrants further investigation.

Journal of the American Heart Association
Boston University (US), University of Vermont (US), University of North Carolina at Chapel Hill (US), Albert Einstein College of Medicine (US), Milken Institute (US), University of Miami (US), Oregon Health & Science University (US), George Washington University (US), University of Washington (US), Cornell University (US), San Diego State University (US), Columbia University Irving Medical Center (US), Hadassah Medical Center (IL), University of Mississippi Medical Center (US), University of Alabama at Birmingham (US), University of Illinois Chicago (US), Weill Cornell Medicine (US), The Ohio State University (US), Columbia University (US), MedStar Health (US)
Good health and well-being
Openalex Percentile: Top 6%
Cardiovascular Health and Risk Factors
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