April 27, 2026Journal of the American Heart Association0 citationsOpen Access
View Full PaperLife's Essential 8 and Risk of Severe COVID‐19 Among Adults Without Clinical Cardiovascular Disease: The C4R Study
Key Result
Higher cardiovascular health, measured by Life's Essential 8, was associated with a 20% lower hazard of severe COVID-19 per 1-SD increase (aHR 0.80; 95% CI 0.73-0.88) in adults without CVD.
Study Design
Type
Cohort (n=29,740)
Multicenter
Yes
Structured PICO
Does better cardiovascular health (measured by Life's Essential 8) reduce the risk of severe COVID-19 in adults without clinical cardiovascular disease?
P
Population
29,740 adults without clinical cardiovascular disease from 9 cohorts (mean age 66±14 years, 61% women, 35% White, 22% Black, 34% Hispanic).
I
Intervention
Higher cardiovascular health as measured by the American Heart Association's Life's Essential 8 (LE8) metric (continuous and categorical: high [≥80] or moderate [50 to <80] CVH).
C
Comparator
Lower cardiovascular health (low CVH [<50] or lower continuous LE8 score).
O
Outcome
Incident severe COVID-19 (hospitalization or death).hard clinical
Better cardiovascular health, as measured by the Life's Essential 8 metric, is associated with a significantly lower risk of severe COVID-19 in adults without pre-existing cardiovascular disease.
Main Result
Effect estimate: aHR 0.80 (95% CI 0.73-0.88)
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.