Study shows an association between better CV health and a lower risk of severe COVID-19.In the C4R* consortium, better cardiovascular health (CVH)—as quantified by the AHA’s** Life’s Essential 8 (LE8)—is associated with a lower risk of severe COVID-19 (ie, hospitalization or death) in individuals without clinical cardiovascular disease (CVD).
LE8 quantifies CVH by including diet, physical activity (PA), smoking, sleep, BMI, blood pressure (BP), lipids, and glucose. Each component is scored from 0 to 100; a higher score means a more optimal CVH. Total LE8 was treated as a continuous variable (per 1-SD higher) and categorized as ‘low CVH’ (LE8 <50), ‘moderate CVH’ (LE8 ≥50 to <80), or ‘high CVH’ (LE8 ≥80). [Circulation 2022;146:e18-e43]
“[We found that] more optimal CVH, particularly BMI, PA, sleep, and BP, was associated with a lower risk of severe COVID-19 events in the first 3 years of the pandemic,” the investigators said.
The incidence rates for severe COVID-19 were 27.9, 19, and 9.8 per 1,000 person-years in the low, moderate, and high CVH categories, respectively.
The risk of severe COVID-19 was halved among participants with high vs low CVH (adjusted hazard ratio [aHR], 0.54); this was not the case for moderate vs low CVH (aHR, 0.81).
There was a 20 percent lower hazard of severe COVID-19 per 1-SD higher LE8 after adjusting for covariates (aHR, 0.80). [J Am Heart Assoc 2026;15:e048256]
Actionable LE8 components
In the model evaluating the individual LE8 components, lower hazards of severe COVID-19 were observed with moderate vs low CVH for PA, BMI, and BP (aHRs, 0.70, 0.73, and 0.77, respectively). A similar pattern was observed between high and low CVH for PA, BMI, BP, glucose, and sleep (aHRs, 0.74, 0.54, 0.70, 0.74, and 0.70, respectively).
In the model that mutually adjusted for all LE8 components, lower hazards of severe COVID-19 were observed with high vs low CVH for PA, BP, sleep, and BMI (aHRs, 0.76, 0.70, 0.67, and 0.63, respectively). “[This] highlights four actionable components of CVH that were independently associated with lower risk of adverse COVID-19 outcomes,” the researchers said.
Prior evidence supports these findings. Several studies have linked higher PA levels with lower risks of severe COVID-19 and non–COVID-19 acute respiratory infections. [JAMA Netw Open 2024;7:e2355808; Br J Sports Med 2021;55:1099-1105; Korean J Fam Med 2014;35:119-126]
“It is possible that the association observed between optimal BP and lower severe COVID-19 risk might be due to lower inflammatory burden, which is strongly linked to hypertension and adverse COVID-19 outcomes,” the researchers noted.
A study found that night-shift workers had a higher risk of developing COVID-19 than day-shift workers, while another study showed that <7 hours of sleep is associated with increased susceptibility to rhinovirus infection. [Chronobiol Int 2022;39:1100-1109; Arch Intern Med 2009;169:62-67]
One study has shown an association between elevated BMI and increased rates of respiratory tract infections. [Int J Obes 2022;46:449-465]
Implications
“There is a critical need to understand how modifiable risk factors relate to COVID-19 risk, as this may inform public health and personal health interventions for COVID-19 and potentially other endemic and emerging infectious diseases,” the researchers explained.
C4R is a multiethnic meta-cohort of 14 established US epidemiologic studies. The analysis included 29,740 participants (mean age 66 years, 61 percent women) from nine cohorts who self-reported COVID-19 via a questionnaire or had it established through active surveillance or serosurvey. Of these, 681 had severe cases.
“Altogether, these results suggest that the LE8 metric could inform risk mitigation and optimal resource allocation for COVID-19 and, potentially, other respiratory infections,” the investigators said.
They called for further studies to ascertain whether CVH optimization could mitigate the risk of adverse outcomes from COVID-19 and other respiratory infections.