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

Authors

• Timothy B. Plante, Department of Medicine Larner College of Medicine at the University of Vermont Burlington VT USA.
• Yifei Sun, Department of Biostatistics Columbia University Mailman School of Public Health New York NY USA.
• Pallavi P. Balte, Department of Medicine, Division of General Medicine Columbia University Irving Medical Center New York NY USA.
• Donald Lloyd-Jones, Framingham Center for Population and Prevention Science Boston University Chobanian and Avedisian School of Medicine Boston MA USA.
• Hongyan Ning, Department of Preventive Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA.
• Norrina Allen, Department of Preventive Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA.
• Morgana Mongraw-Chaffin, MedStar Health Research Institute, Population Health Research Columbia MD USA.
• Kelley Pettee Gabriel, Department of Epidemiology University of Alabama at Birmingham AL USA.
• Vanessa Xanthakis, Department of Medicine Boston University Chobanian and Avedisian School of Medicine Boston MA USA.
• Arnita F. Norwood, Department of Medicine University of Mississippi Medical Center Jackson MS USA.
• Sara Gonzalez, Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY USA.
• Daniela Sotres-Alvarez, Department of Biostatistics University of North Carolina at Chapel Hill NC USA.
• Gregory A. Talavera, Department of Psychology San Diego State University San Diego CA USA.
• Martha L. Daviglus, Institute for Minority Health Research University of Illinois Chicago IL USA.
• Sameera A. Talegawkar, Department of Exercise and Nutrition Sciences Milken Institute School of Public Health at the George Washington University Washington DC USA.
• Namratha Kandula, Department of Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA.
• Mitchell S. Elkind, Department of Neurology, Vagelos College of Physicians and Surgeons Columbia University New York NY USA.
• Tatjana Rundek, Department of Neurology University of Miami Miller School of Medicine Miami FL USA.
• Jose Gutierrez, Department of Neurology University of Miami Miller School of Medicine Miami FL USA.
• Emily B. Levitan, Department of Epidemiology University of Alabama at Birmingham AL USA.
• Mary Cushman, Department of Medicine Larner College of Medicine at the University of Vermont Burlington VT USA.
• Suzanne E. Judd, Department of Health Behavior University of Alabama at Birmingham AL USA.
• Henry E. Wang, Department of Emergency Medicine The Ohio State University Columbus OH USA.
• Neil A. Zakai, Department of Medicine Larner College of Medicine at the University of Vermont Burlington VT USA.
• Virginia J. Howard, Department of Epidemiology University of Alabama at Birmingham AL USA.
• Nathalie Pamir, Knight Cardiovascular Institute, Center for Preventive Cardiology Oregon Health and Science University Portland OR USA.
• Monika M. Safford, Department of Medicine Weill Cornell Medicine New York NY USA.
• Debora Kamin Mukaz, Department of Medicine Larner College of Medicine at the University of Vermont Burlington VT USA.
• Amanda M. Fretts, Department of Epidemiology University of Washington Seattle WA USA.
• Stephen P. Juraschek, Department of Medicine Beth Israel Deaconess Medical Center Boston MA USA.
• Elizabeth C. Oelsner, Department of Medicine, Division of General Medicine Columbia University Irving Medical Center New York NY USA.

Document Type

Journal Article

Publication Date

4-27-2026

Journal

Journal of the American Heart Association

DOI

10.1161/JAHA.125.048256

Keywords

COVID‐19; Life's Essential 8; SARS‐CoV‐2; cardiovascular health; cohort study; epidemiology

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.

APA Citation

Plante, Timothy B.; Sun, Yifei; Balte, Pallavi P.; Lloyd-Jones, Donald; Ning, Hongyan; Allen, Norrina; Mongraw-Chaffin, Morgana; Pettee Gabriel, Kelley; Xanthakis, Vanessa; Norwood, Arnita F.; Gonzalez, Sara; Sotres-Alvarez, Daniela; Talavera, Gregory A.; Daviglus, Martha L.; Talegawkar, Sameera A.; Kandula, Namratha; Elkind, Mitchell S.; Rundek, Tatjana; Gutierrez, Jose; Levitan, Emily B.; Cushman, Mary; Judd, Suzanne E.; Wang, Henry E.; Zakai, Neil A.; Howard, Virginia J.; Pamir, Nathalie; Safford, Monika M.; Kamin Mukaz, Debora; Fretts, Amanda M.; Juraschek, Stephen P.; and Oelsner, Elizabeth C., "Life's Essential 8 and Risk of Severe COVID-19 Among Adults Without Clinical Cardiovascular Disease: The C4R Study" (2026). GW Authored Works. Paper 9015.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/9015

Department

Exercise and Nutrition Sciences