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Life's Essential 8 and Risk of Severe COVID-19 Among Adults Without Clinical Cardiovascular Disease: The C4R Study
Timothy B Plante1, Yifei Sun2, Pallavi P Balte3
1Department of Medicine Larner College of Medicine at the University of Vermont Burlington VT USA.
Insights
Maintaining good cardiovascular health (CVH) significantly lowers the risk of severe COVID-19 in adults without pre-existing heart conditions. Optimizing CVH through lifestyle factors may offer protection against severe viral infections.
Area of Science:
- Public Health
- Epidemiology
- Cardiology
Background:
- Cardiovascular disease (CVD) is a known risk factor for severe COVID-19 outcomes.
- The association between cardiovascular health (CVH) and severe COVID-19 risk in individuals without CVD is not well understood.
Purpose of the Study:
- To investigate if the American Heart Association's Life's Essential 8 (LE8) metric and its components are associated with a reduced risk of severe COVID-19.
- To assess the relationship between CVH and severe COVID-19 in adults without prior cardiovascular disease.
Main Methods:
- The study analyzed data from the C4R (Collaborative Cohort of Cohorts for COVID-19 Research) consortium, excluding participants with pre-existing cardiovascular disease.
- COVID-19 infections and severity were identified through questionnaires, surveillance, and serosurveys.
- Adjusted cause-specific hazards models were used to test associations between the LE8 metric (continuous and categorical) and severe COVID-19.
Main Results:
- A total of 29,740 participants were included, with 681 cases of severe COVID-19.
- Higher overall CVH (per 1-SD increase in LE8 score) was associated with a 20% lower hazard of severe COVID-19.
- High CVH (LE8 score ≥80) showed a significant reduction in severe COVID-19 risk (aHR, 0.54), while moderate CVH did not (aHR, 0.81).
- Improved physical activity, body mass index, blood pressure, and sleep were individually linked to a lower hazard of severe COVID-19.
Conclusions:
- Better cardiovascular health is linked to a lower risk of severe COVID-19 among adults without cardiovascular disease.
- Further research is warranted to explore if optimizing CVH can mitigate risks associated with COVID-19 and other viral infections.
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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