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.