The American Heart Association released a new scientific statement emphasizing the link between cardiovascular and brain health. The "Cardiac Contributions to Brain Health" statement highlights that managing heart health early in life can significantly reduce the risk of stroke and cognitive decline later in life.
American Heart Association Statement Highlights
A significant portion (14-81%) of heart failure patients experience a decline in cognitive abilities, impacting their language skills, memory, and ability to plan and organize.
Individuals with atrial fibrillation are 39% more likely to develop memory or thinking problems, while adults with heart disease have a 27% higher risk of dementia.
Up to half of all individuals experience cognitive decline after a heart attack.
These findings underscore the importance of prioritizing heart health from a young age to prevent heart disease and safeguard brain health and reduce the risk of cognitive impairment later in life.
Cardiovascular Disease Impacts Brain Health
Research indicates a strong connection between common cardiovascular diseases like heart failure, atrial fibrillation, and coronary heart disease and an increased risk of cognitive impairment and dementia. For instance, studies show that nearly half of individuals with heart failure experience some form of cognitive impairment, and those with atrial fibrillation have a 39% higher risk of developing thinking and memory problems. Furthermore, coronary heart disease increases the risk of dementia by 27%, with up to half of individuals experiencing cognitive decline following a heart attack.
The statement emphasizes that these cardiovascular conditions can damage the brain in several ways, including reduced blood flow, inflammation, and shared risk factors like high blood pressure and Type 2 diabetes. It stresses the importance of early intervention and managing heart conditions to preserve brain health and reduce the risk of cognitive decline. Dr. Fernando Testai, chair of the statement writing group, highlights that while research into new treatments for dementia is ongoing, prevention through a healthy lifestyle and proactive cardiovascular care is crucial.
The epidemiological and basic science research evidence confirms a strong connection between cardiac and brain health, influenced by modifiable and nonmodifiable factors. Observational studies show that cardiac diseases are associated with brain pathologies, such as microstructural changes, covert brain infarction, stroke, and hypoperfusion. Preclinical models demonstrate that proinflammatory pathways, oxidative stress, blood-brain barrier (BBB) dysfunction, and microvascular dysregulation contribute to cognitive impairment in individuals with heart disease. Genetic links between cardiac and brain abnormalities have also been identified through Mendelian randomization. However, there are still gaps in understanding how cardiac disease affects cognition, especially regarding the benefits of cardiac treatments on age-related cognitive decline.
Conclusion
Despite advances in research, there is limited evidence that managing cardiac diseases positively impacts cognitive health. Some cardiovascular procedures, like coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement, may even increase the risk of stroke and negatively affect cognition. Certain medications, such as statins and antihypertensives, have been linked to improved cognitive performance, though more research is needed to confirm these effects. Inflammation plays a role in both cardiac disease and dementia, including Alzheimer's disease, but the benefits of immunomodulation for cognitive function remain unclear.
The research also highlights the role of genetic, social, environmental, and lifestyle factors across the lifespan in influencing both cardiac and brain health. Cardiovascular risk factors, such as obesity, a sedentary lifestyle, and substance use, contribute to both heart disease and cognitive impairment. Furthermore, the underrepresentation of minority groups in studies limits the generalizability of current findings.
Public health initiatives should focus on preventing cardiac disease, emphasizing early lifestyle interventions to protect cognitive health. Education campaigns promoting healthy habits could help reduce the burden of dementia. While monoclonal antibody therapies targeting amyloid-β offer hope for Alzheimer's treatment, prevention remains the most effective strategy. Clinically, adopting cardiovascular health guidelines and interventions such as Life's Essential 8 can help address the growing prevalence of cognitive impairments and improve overall brain health throughout the lifespan.
Open-Access Article
Testai, F. D., Gorelick, P. B., Chuang, P. Y., Dai, X., Furie, K. L., Gottesman, R. F., Iturrizaga, J. C., Lazar, R. M., Russo, A. M., Seshadri, S., Wan, E. Y., & American Heart Association Stroke Council; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension (2024). Cardiac Contributions to Brain Health: A Scientific Statement From the American Heart Association. Stroke, 10.1161/STR.0000000000000476. Advance online publication. https://doi.org/10.1161/STR.0000000000000476
Glossary
amyloid-β (Aβ): a protein fragment that forms the core component of amyloid plaques, which are abnormal accumulations found in the brains of individuals with Alzheimer's disease. Amyloid-β is produced when a larger protein, amyloid precursor protein (APP), is cleaved by specific enzymes. In Alzheimer's, amyloid-β aggregates into plaques that disrupt cell function, contributing to neurodegeneration and cognitive decline.
atrial fibrillation (AFib): a common arrhythmia characterized by an irregular and often rapid heart rate, resulting from disorganized electrical signals in the atria. AFib can lead to poor blood flow, increasing the risk of stroke, heart failure, and other heart-related complications.
blood-brain barrier (BBB) dysfunction: a condition where the protective barrier between the brain’s blood vessels and the brain tissue is compromised. This dysfunction can allow harmful substances to enter the brain, contributing to neuroinflammation and cognitive impairment, particularly in individuals with cardiovascular disease.
coronary artery bypass grafting (CABG): a surgical procedure used to improve blood flow to the heart by bypassing blocked coronary arteries. It involves using a graft from another part of the body (e.g., leg vein) to create an alternate pathway for blood to reach the heart muscle. CABG is commonly performed in patients with severe coronary artery disease.
coronary heart disease (CHD): a condition caused by the narrowing or blockage of coronary arteries due to the buildup of atherosclerotic plaques. This impairs blood flow to the heart muscle, leading to symptoms like angina and increasing the risk of heart attack.
covert brain infarction: a silent or asymptomatic stroke that causes brain tissue damage without noticeable clinical symptoms. It is often detected incidentally during brain imaging and can contribute to long-term cognitive decline, especially in patients with cardiovascular conditions.
dementia: a broad category of neurodegenerative disorders characterized by a progressive decline in cognitive function, including memory, reasoning, and communication skills. Alzheimer's disease is the most common form of dementia.
heart failure (HF): a chronic condition where the heart is unable to pump blood efficiently enough to meet the body's needs. This can result from conditions like coronary artery disease, high blood pressure, or cardiomyopathy, leading to symptoms such as shortness of breath, fatigue, and fluid retention.
hypoperfusion: a condition characterized by reduced blood flow to an organ or tissue, resulting in insufficient oxygen and nutrient delivery. In the brain, hypoperfusion can lead to ischemic damage, cognitive decline, and an increased risk of stroke.
Life's Essential 8: a set of evidence-based guidelines developed by the American Heart Association to promote cardiovascular and overall health. The eight components include healthy diet, physical activity, nicotine avoidance, healthy weight, managing cholesterol, managing blood pressure, controlling blood sugar, and getting adequate sleep.
Mendelian randomization: a genetic epidemiology method that uses genetic variants as tools to assess causal relationships between risk factors (such as cardiovascular disease) and outcomes (such as cognitive impairment). It provides a way to infer causality in observational studies by reducing confounding factors.
microvascular dysregulation: abnormal function of small blood vessels (microvasculature), often contributing to impaired blood flow and tissue oxygenation. In the brain, microvascular dysregulation can lead to ischemic injury, stroke, and cognitive decline, particularly in individuals with cardiovascular disease.
oxidative stress: a harmful condition that occurs when there is an imbalance between the production of free radicals (reactive oxygen species) and the body’s ability to neutralize them with antioxidants. Oxidative stress contributes to tissue damage, inflammation, and diseases such as atherosclerosis, stroke, and neurodegeneration.
proinflammatory pathways: biological processes that lead to increased production of inflammatory molecules, such as cytokines and chemokines. These pathways are activated in response to injury or infection but can also contribute to chronic inflammation, which is implicated in cardiovascular disease and cognitive decline.
stroke: a medical emergency caused by an interruption of blood supply to the brain, leading to brain tissue damage. Strokes can be ischemic (caused by a blockage) or hemorrhagic (caused by bleeding). Symptoms include sudden weakness, speech difficulties, and vision problems. Strokes are a major cause of disability and death worldwide.
transcatheter aortic valve replacement (TAVR): a minimally invasive procedure used to replace a narrowed aortic valve (aortic stenosis) in patients at high risk for open-heart surgery. A catheter is used to deliver and implant a new valve, improving blood flow and reducing symptoms such as chest pain and shortness of breath.
type 2 diabetes (T2D): a metabolic disorder characterized by insulin resistance and relative insulin deficiency, leading to elevated blood glucose levels. T2D is often associated with obesity and can result in long-term complications such as cardiovascular disease, neuropathy, and kidney damage.
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