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Cardiometabolic disease is associated with mortality and requirement for ventilation in COVID-19. Symptomatic atherosclerotic cardiovascular disease (CVD) implies the presence of significant endothelial dysfunction and is a risk factor for severe COVID-19. However, many patients with no history of CVD exhibit severe COVID-19. We hypothesised that CVD risk calculators could serve as a proxy for significant endothelial dysfunction and predict COVID-19 outcomes in those without symptomatic CVD. We reviewed 230 patients aged 35 to 65 years, hospitalized with COVID-19 at our institution. 190 patients with no history of symptomatic CVD were included. 23% developed severe respiratory failure (RF, requiring mechanical or non-invasive ventilation), while 4% (7/164) of those without prior end-stage renal disease required renal replacement therapy (RRT). In univariate analysis, age (β = 0.057 ± 0.02, p= 0.02), BMI (β = 0.05 ± 0.03, p = 0.049) and T2DM (β = 0.81 ± 0.41, p = 0.048) predicted RF. In keeping with a link between insulin resistance and severe COVID-19, an association was observed between triglycerides and RF (β = 0.26 ± 0.14, P = 0.058). CVD risk indices QRISK3 (0.07 ± 0.02, P We observed a threshold effect for QRISK3: when 10 year risk of a CV event was > 5% the risk of RF markedly increased (OR: 6.86 (95% CI: 2.30 - 20.5, P5%. A similar trend was observed when analysis was limited to those with T2DM (Ventilatory support in T2DM: QRISK5%: 11/30). All cases of RRT occurred in those with QRISK >5%. CVD risk calculators predict severe COVID-19, supporting a role for subclinical CVD in severe COVID-19. Patients hospitalized with QRISK3 >5% may be candidates for early intervention and enhanced monitoring. Disclosure S. Lockhart: None. A. Sheikh: None. H. Griffiths: None. J. Calvo latorre: None. A. B. Daly: None. L. Sibal: None. Funding National Institute for Health Research